Abstract
Insulin autoimmune syndrome (IAS) is a rare cause of spontaneous hypoglycemia with severe hyperinsulinemia characterized by high titers of insulin antibodies (IAs) without prior insulin injections (1). Whereas IAS is usually caused by drugs containing sulfhydryl compounds or α-lipoic acid (2), we report a disease resembling IAS, possibly induced by insulin glulisine. A 71-year-old man was diagnosed with type 2 diabetes at 62 years of age in 2003. While he was treated with glimepiride from 2009, his glycemic control remained poor. In October 2010, glimepiride was discontinued and four daily insulin injections, three injections of glulisine and one injection of glargine, were initiated. From around February 2011, he repeatedly suffered nocturnal hypoglycemia along with daytime hyperglycemia. Although glargine was discontinued in July 2011, nocturnal hypoglycemia continued to occur. Therefore, he was admitted to our hospital in May 2012. When three daily glulisine injections (0.52 units/kg/day) were continued …
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