scholarly journals Insulin autoimmune syndrome induced by exogenous insulin injection: a four-case series

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yimin Shen ◽  
Xiaoxiao Song ◽  
Yuezhong Ren
Keyword(s):  
Diabetes Mellitus ◽  
Case Series ◽  
Insulin Injection ◽  
Insulin Autoantibodies ◽  
Hyperinsulinemic Hypoglycemia ◽  
Exogenous Insulin ◽  
Case Presentation ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome ◽  
Patients With Diabetes

Abstract Background Insulin autoimmune syndrome (IAS) is a rare cause of hypoglycemia and is characterized by the presence of insulin autoantibodies. Patients with IAS usually complain of hypoglycemia without any previous insulin received. Glucocorticoids and immunosuppressants are used to treat IAS. Case presentation We report four patients with diabetes who were diagnosed with non-classical IAS and describe the treatment of these patients. Moreover, the differential diagnosis with hyperinsulinism is discussed. Conclusion High levels of insulin autoantibodies, as well as hyperinsulinemic hypoglycemia, are found in patients with diabetes mellitus and prior exogenous insulin exposure. This situation that we classified as non-classical IAS should be attached importance to.

Insulin autoimmune syndrome: a rare cause of spontaneous hypoglycaemia in non-diabetic individuals

2020 ◽  
Vol 13 (12) ◽  
pp. e234448
Author(s):  
Shruthi Ravindra ◽  
Sahana Shetty
Keyword(s):  
Endoscopic Ultrasound ◽  
Insulin Autoantibodies ◽  
Exogenous Insulin ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome ◽  
Pancreatic Tumour ◽  
Biochemical Evaluation ◽  
Antibody Levels ◽  
Hyperinsulinemic Hypoglycaemia

Insulin autoimmune syndrome (IAS) is a rare cause of hypoglycaemia, characterised by recurrent hypoglycaemic episodes secondary to insulin autoantibodies in individuals who are not exposed to exogenous insulin. We are reporting a case of IAS in a 64-year-old gentleman, who presented with predominant postprandial hypoglycaemic episodes. On biochemical evaluation, he was found to have hyperinsulinemic hypoglycaemia. Localisation studies with MRI abdomen and endoscopic ultrasound (EUS) were negative for pancreatic tumour. Tests sent for insulin antibody levels were elevated. The patient was treated with frequent meals, acarbose and glucocorticoids. Patient condition improved and did not experience hypoglycaemia on follow-up.

scholarly journals Hyperinsulinemic hypoglycemia associated with insulin antibodies caused by exogenous insulin analog

2016 ◽  
Vol 2016 ◽  
Author(s):  
Chih-Ting Su ◽  
Yi-Chun Lin
Keyword(s):  
High Serum ◽  
Insulin Antibodies ◽  
Insulin Analog ◽  
Hyperinsulinemic Hypoglycemia ◽  
Oral Glucose ◽  
List Type ◽  
Exogenous Insulin ◽  
C Peptide ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome

Summary Insulin antibodies (IA) associated with exogenous insulin administration seldom caused hypoglycemia and had different characteristics from insulin autoantibodies (IAA) found in insulin autoimmune syndrome (IAS), which was first described by Dr Hirata in 1970. The characteristic of IAS is the presence of insulin-binding autoantibodies and related fasting or late postprandial hypoglycemia. Here, we report a patient with type 1 diabetes mellitus under insulin glargine and insulin aspart treatment who developed recurrent spontaneous post-absorptive hyperinsulinemic hypoglycemia with the cause probably being insulin antibodies induced by exogenous injected insulin. Examinations of serial sera disclosed a high titre of insulin antibodies (33%, normal <5%), high insulin concentration (111.9 IU/mL) and undetectable C-peptide when hypoglycemia occurred. An oral glucose tolerance test revealed persistent high serum levels of total insulin and undetectable C-peptide. Image studies of the pancreas were unremarkable, which excluded the diagnosis of insulinoma. The patient does not take any of the medications containing sulfhydryl compounds, which had been reported to cause IAS. After administering oral prednisolone for 3 weeks, hypoglycemic episodes markedly improved, and he was discharged smoothly. Learning points: Insulin autoimmune syndrome (IAS) or IAS-like situation should be one of the differential diagnosis in patients with hyperinsulinemic hypoglycemia. Although less reported, insulin antibodies (IA) caused by exogenous insulin analog should be considered as the cause of hypoglycemia. Patients with suspected insulin autoimmune syndrome (IAS) should be screened for drugs related to autoimmunity to endogenous insulin.

CASE SERIES: A SPECTRUM OF FUNGAL INFECTIONS IN COVID-19

2021 ◽  
pp. 29-30
Author(s):  
Venkatesh B. C. ◽  
Rajendra Rao K. M. ◽  
K. N. Mohan Rao
Keyword(s):  
Diabetes Mellitus ◽  
Fungal Infections ◽  
Virus Disease ◽  
Case Series ◽  
Health Crisis ◽  
Major Health ◽  
Corona Virus ◽  
Patients With Diabetes ◽  
Causative Agents

Corona virus Disease 2019 (COVID-19) pandemic is causing a major health crisis across the globe. With the increasing number of fungal infections associated with COVID-19 being reported, it is imperative to understand the spectrum of such infections. Most documented cases have been reported in patients with diabetes mellitus or treatment with immunomodulators. The most common causative agents are Aspergillus, Candida or Mucorales. This series aims to portray the spectrum of fungal infections associated with COVID-19.

Using mobile phone text messages to improve insulin injection technique and glycaemic control in patients with diabetes mellitus: a multi-centre study in Turkey

2014 ◽  
Vol 24 (11-12) ◽  
pp. 1525-1533 ◽  
Author(s):  
Selda Celik ◽  
Gulhan Cosansu ◽  
Semra Erdogan ◽  
Alev Kahraman ◽  
Sengul Isik ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Glycaemic Control ◽  
Mobile Phone ◽  
Insulin Injection ◽  
Text Messages ◽  
Injection Technique ◽  
Multi Centre Study ◽  
Centre Study ◽  
Patients With Diabetes

scholarly journals Insulin Autoimmune Syndrome – A Case Series

2020 ◽  
Vol 16 (2) ◽  
pp. 168
Author(s):  
Hiya Boro ◽  
Uttio Gupta ◽  
Charandeep Singh ◽  
Rakhi Malhotra ◽  
Rajesh Khadgawat ◽  
...  
Keyword(s):  
Case Series ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome

Abstract P363: Predictors of Utility of Advanced Cardiac Imaging in Revealing Cryptogenic Stroke Etiology

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Daniel M Schachter ◽  
Micaela Schachter ◽  
Blake Beehler ◽  
Jeffrey Quinn ◽  
Jeremy E Kulacz ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiac Imaging ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Case Series ◽  
Patient Characteristics ◽  
Current Data ◽  
Common Finding ◽  
Retrospective Case ◽  
Patients With Diabetes

Introduction: Advanced cardiac imaging (ACI), including transesophageal echocardiogram (TEE), cardiac CT and cardiac MRI, is widely considered a crucial element in the work-up of cryptogenic and ESUS stroke. Current data on diagnostic yields are variable, though, and selection of patients to undergo such imaging is largely anecdotal. Methodology: We conducted a retrospective case series review of all cryptogenic ischemic strokes who received ACI, admitted to a large urban academic single-center over a 2.5-year period. Patient characteristics and imaging findings were analyzed to determine diagnostic yields and to identify positive and negative predictors that ACI would uncover etiology. Results: Out of 277 total cryptogenic ischemic strokes reviewed, ACI determined etiology in 20 cases (7.2%). Median age was 61 (IQR = 52-73). Patient sex was 49.5% female. Race demographic was 1.8% Asian, 50.9% black, 14.1% latino(a), and 33.2% white. Etiology was found by TEE in 16 of 20 cases, and the most common finding was left atrial thrombus/smoke. Latino(a) race was significantly more likely (15.4%) for ACI to find etiology and white race was significantly less likely (1.1%), p = .03 and .005, respectively. The table included shows other notable findings. Analogous trends were observed in a subgroup analysis of patients greater or equal to 60 years old. Conclusion: Our data indicate that in cryptogenic stroke premorbid non-use of antithrombotic, elevated troponin and left atrial dilatation are each individually associated with increased likelihood that ACI will find an etiology. Meanwhile, patients with diabetes mellitus are significantly less likely to have etiology found by ACI; and, smokers with combined hypertension, hyperlipidemia, and diabetes mellitus trend towards ACI less frequently uncovering etiology. Finally, the data suggest potential racial disparities of finding etiology with ACI, the determinants of which remain to be studied.

Insulin autoimmune syndrome in a methimazole-treated Graves' patient with polyclonal anti-insulin autoantibodies

1987 ◽  
Vol 3 ◽  
pp. S39-S39
Author(s):  
YAUJIUNNLEE ◽  
SHYIJANGSHIN ◽  
JIAKANNTORNG ◽  
WENJANGLIU ◽  
YUNGHSIUNGLAI ◽  
...  
Keyword(s):  
Insulin Autoantibodies ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome

Pitfalls in the diagnosis of insulin autoimmune syndrome (Hirata’s disease) in a hypoglycemic child: a case report and review of the literature

2019 ◽  
Vol 32 (4) ◽  
pp. 421-428 ◽  
Author(s):  
Tiago Jeronimo Dos Santos ◽  
Caroline Gouvêa Buff Passone ◽  
Marina Ybarra ◽  
Simone Sakura Ito ◽  
Milena Gurgel Teles ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Previous History ◽  
Human Leukocyte ◽  
Hyperinsulinemic Hypoglycemia ◽  
Insulin Levels ◽  
Insulin Autoimmune Syndrome ◽  
Endogenous Insulin ◽  
Autoimmune Syndrome ◽  
Insulin Autoantibody ◽  
Control Food Intake

Abstract Background Insulin autoimmune syndrome (IAS) is a rare cause of hyperinsulinemic hypoglycemia (HH) not addressed as a potential differential diagnosis in current pediatric guidelines. We present a case of IAS in a child with no previous history of autoimmune disease, no previous intake of triggering medications and absence of genetic predisposition. Case presentation A 6-year-old boy presented with recurrent HH (blood glucose of 26 mg/dL [1.4 mmol/L] and insulin of 686 μU/mL). Abdominal imaging was normal. After multiple therapeutic failures, we hypothesized misuse of exogenous insulin and factitious hypoglycemia. Council of Guardianship had the child separated from his mother, but insulin levels remained high. A chromatography test was then performed which showed high titers of endogenous insulin autoantibody (IAA) with early dissociation from the insulin molecule. The human leukocyte antigen (HLA) test showed a DRB1 *13:01/*08:02 genotype. The patient was advised to control food intake and physical activity routines. During a 5-year follow-up, hypoglycemic episodes were sparse, despite high insulin levels. Conclusions Misdiagnosis of IAS with factitious hypoglycemia may happen if IAS is not considered as a differential diagnosis, leading to potential traumatic consequences. Further efforts should be made to increase awareness of IAS as a differential diagnosis of hypoglycemia and to include it in pediatric guidelines.

scholarly journals Assessment and Management of Anti-Insulin Autoantibodies in Varying Presentations of Insulin Autoimmune Syndrome

2018 ◽  
Vol 103 (10) ◽  
pp. 3845-3855 ◽  
Author(s):  
David Church ◽  
Luís Cardoso ◽  
Richard G Kay ◽  
Claire L Williams ◽  
Bernard Freudenthal ◽  
...  
Keyword(s):  
Insulin Autoantibodies ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome

scholarly journals Hypoglycemia due to insulin autoimmune syndrome (Hirata’s disease): a rare cause of hypoglycaemia

2021 ◽  
Vol 8 (8) ◽  
pp. 1220
Author(s):  
Het V. Patel ◽  
Sunil Kumar ◽  
Kalpesh Moradiya ◽  
Vidhi Shah
Keyword(s):  
Nutrition Therapy ◽  
Serum Glucose ◽  
Insulin Antibodies ◽  
Laboratory Evaluation ◽  
Hyperinsulinemic Hypoglycemia ◽  
Lifestyle Modifications ◽  
Glucose Levels ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome ◽  
Recurrent Hypoglycaemia

Although the most common cause of recurrent hypoglycaemia is diabetes mellitus as patient is on antidiabetic medications which can be prevented by modification of antidiabetic doses, nutrition therapy and lifestyle modifications. Some endogenous hyperinsulinemic conditions like insulinoma, functional beta cell disorders and insulin autoimmune syndromes, hormonal deficiencies can cause serious and sometimes life threatening hypoglycaemia. So further laboratory evaluation like plasma/serum glucose levels, c-peptide levels, insulin levels, insulin antibodies and imaging studies are needed to evaluate unexplained hypoglycaemia. Here we report a case of insulin autoimmune syndrome in a 67 year old Indian male who had presented to us with multiple episodes of spontaneous hypoglycaemia. On further workup, the patient was found to have endogenous hyperinsulinemic hypoglycemia. As the patient’s abdominal imaging revealed no apparent cause of EHH, on further evaluation he came positive for insulin antibodies. Patient was diagnosed as IAS and he was given frequent small meals and complex carbohydrate diet and he had improved symptomatically. The incidence of IAS is most common in Japan and very few cases have been reported from India, so it should be kept in differential diagnosis of recurrent hypoglycaemia.

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