ABSTRACT
In the past, it was thought that insulin autoantibodies (IAA) produced by exogenous insulin and its analogues rarely had clinical significance. However, in recent years, with the increase in the incidence of diabetes and the use of insulin, more and more exogenous IAA produced by insulin causes serious clinical harm, and clear detection methods and treatment methods are limited. A large proportion of such patients are therefore missed, which seriously affects the blood glucose control and quality of life of patients with type 2 diabetes who receive insulin therapy. This article reviews the current diagnosis and treatment progress of exogenous insulin antibody syndrome in patients with type 2 diabetes.
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AIM: To explore the clinical features of insulin autoimmune syndrome (IAS) induced by methimazole in Chinese population. METHODS: The literature on IAS cases caused by methimazole in the Chinese population published before and after June 30, 2019 was collected for retrospective analysis.RESULTS:The age of onset of men was earlier than that of women, and the sex ratio was 1:2.31 in 95 patients.After taking methimazole 30 mg/d, IAS occurred most from one month to three months,characterized by neuropathic hypoglycemia as the first symptoms at night and early in the morning,blood sugar below 2 mmol/L,insulin concentration≥100 mU/L, IAA positive and no obvious abnormalities in pancreas imaging.The symptoms gradually relieved after symptomatic treatment and stopped taking methimazole. There was no significant difference in the time of hypoglycemia disappearance between the 54 patients who received hormone therapy and non-hormone therapy.CONCLUSION:Methimazole-induced IAS is a clinically rare autoimmune disease. It should be treated promptly occuring hypoglycemia or hyperglycemia during medication.The prognosis of IAS is generally good after proper treatment.
ABSTRACT
Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia, extremely high serum insulin levels, and high titers of autoantibodies against endogenous insulin, in the absence of exogenous insulin injection. IAS often occurs following exposure to sulfhydryl-containing drugs, including alpha-lipoic acid (ALA). A 30-year-old woman without diabetes visited our outpatient clinic with recurrent hypoglycemia. She had been taken ALA for weight reduction since 3 weeks ago. Further hypoglycemia work up revealed very high insulin levels, C-Peptide levels and positive insulin antibodies. And conventional imaging examinations were negative for insulinoma or other pancreatic tumors. Finally, the diagnosis of Insulin autoimmune syndrome (IAS) was made. Following the cessation of ALA, hypoglycemia improved, with no medication, and the patient experienced no further hypoglycemic attacks over the next month. The use of ALA as a nutritional supplement is increasing. We report a case of IAS associated with ALA in a non-diabetic patient.
Subject(s)
Adult , Female , Humans , Ambulatory Care Facilities , Autoantibodies , C-Peptide , Diagnosis , Hypoglycemia , Insulin Antibodies , Insulin , Insulinoma , Thioctic Acid , Weight LossABSTRACT
Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia, extremely high serum insulin levels, and high titers of autoantibodies against endogenous insulin, in the absence of exogenous insulin injection. IAS often occurs following exposure to sulfhydryl-containing drugs, including alpha-lipoic acid (ALA). A 30-year-old woman without diabetes visited our outpatient clinic with recurrent hypoglycemia. She had been taken ALA for weight reduction since 3 weeks ago. Further hypoglycemia work up revealed very high insulin levels, C-Peptide levels and positive insulin antibodies. And conventional imaging examinations were negative for insulinoma or other pancreatic tumors. Finally, the diagnosis of Insulin autoimmune syndrome (IAS) was made. Following the cessation of ALA, hypoglycemia improved, with no medication, and the patient experienced no further hypoglycemic attacks over the next month. The use of ALA as a nutritional supplement is increasing. We report a case of IAS associated with ALA in a non-diabetic patient.
Subject(s)
Adult , Female , Humans , Ambulatory Care Facilities , Autoantibodies , C-Peptide , Diagnosis , Hypoglycemia , Insulin Antibodies , Insulin , Insulinoma , Thioctic Acid , Weight LossABSTRACT
Objective:To know the clinical features of insulin autoimmune syndrome to improve diagnostic level. Methods:Focused oninsulin autoimmune syndrome ( IAS ), to make retrospective analysis by summarizing medical history, clinical manifestations,insulin levels,treatment and prognosis of 71 IAS cases recently fifteen years reported in the literature on CNKI. Results:Among the 71 IAS cases,there were 40 cases with a history of hyperthyroidism,31 cases taking methimazole before onset and 43 cases with hypoglycemic episodes with clear regularity, of which 30 cases hypoglycemic episodes occurred during the night or on early morning. 35 cases had disorders of consciousness and such patients had lower blood glucose level and higher insulin level; 36 cases received hormone therapy with shorter time for IAA turning negative,and 26 cases only stopped taking the causative drug;69 cases have a remission,1 case prognosis was unknown due to auto-discharge,and 1 case dies of combined pleural endotheliomas. Conclusion:IAS is one of the important causes of severe spontaneous hypoglycemia and is clinically relatively rare. It often combines with autoimmune diseases,induced by hydroxyl drug and vulnerable to disturbance of consciousness. Patients who have disorders of consciousness should be treated with hormonotherapy in time. Early identification and appropriate treatment generally lead to good prognosis.
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Objective To analyze the clinical characteristics and prognosis of patients with insulin autoimmune syndrome (IAS) and to get better understanding of IAS by literatures reviewing.Methods Nine cases of IAS who were diagnosed in the General Hospital of the People's Liberation Army from 2001 to 2011 were analyzed.Results All patients had hypoglycemic syndrome and episodes of hypoglycemia during both postprandial and fasting states.Most cases (8/9) were accompanied with autoimmune diseases,including 6 cases of Graves' disease treated with methimazole.The biochemical data showed extremely elevated serum insulin level (9/9) during hypoglycemic episode.For most patients,the tests of insulin autoantibodies were positive (7/9) while results of imaging examinations were negative(8/9).After removal of possible offending medications and with diet treatment,hypoglycemic episodes were ameliorated in 5 of 9 cases.For severe patients,acarbose (1/9) and prednisone (3/9)therapy were useful.During the period of follow-up,four cases experienced no episode of hypoglycemia and 3 cases with markedly reduced episodes.Conclusions IAS is characterized by hypoglycemic episodes,elevated blood insulin levels,and positive insulin autoantibodies.It is strongly related with autoimmune disease and is able to be induced by methimazole.Most patients undergo remission after diet treatment,drug withdrawal,and oral prednisone.
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Insulin autoimmune syndrome (IAS) is rare.A patient with IAS was herewith reported and 50domestic cases reported in the last two decades were reviewed to discuss the approach to this syndrome.In hypoglycemic patients with high insulin level and with Graves' disease and taking tapazole,insulin autoantibody detection is mandatory to avoid misdiagnosis and unnecessary surgery.
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Objective To evaluate the significance of combined determination of glutamic acid decarboxylase antibodies(GADA),islet cell antibodies(ICA) and insulin autoantibodies (IAA) in predictive of type 1 diabetes mellitus Methods GADA, ICA and IAA were determined by enzyme linked immunosorbent assay and C peptide by radioimmunoassay Diagnose efficiency were calculated by matrix decision method Results The positive rate of GADA,ICA and IAA(68 8%,43 0% and 39 8%) were significantly elevated in the patients with type 1 diabetes mellitus compared with type 2 diabetes mellitus or normal subjects ( P