scholarly journals “The Unusual Suspect” - Insulin Autoimmune Syndrome, an Extremely Rare Cause of Hypoglycemia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A355-A355
Author(s):  
Hassaan B Aftab ◽  
Carl D Malchoff
Keyword(s):  
Insulin Antibody ◽  
Diabetic Patients ◽  
High Dose ◽  
Blood Draw ◽  
Family History Of Diabetes ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome ◽  
Asian Descent ◽  
History Of ◽  
Antibody Titers

Abstract Background: Insulin autoimmune syndrome (IAS), also called Hirata syndrome, is a rare diagnosis which is characterized by hypoglycemia, normal or elevated fasting insulin level, and elevated anti-insulin antibody titers. Clinical Case: 45-year-old nondiabetic Caucasian female presented to the emergency department (ED) with chief complaint of near-syncope. She reported difficulty concentrating and feeling faint roughly 1 hour after consuming breakfast. Upon ED arrival, fingerstick glucose (FSG) was 47 mg/dL. Her symptoms resolved with ingestion of orange juice and repeat blood glucose (BG) 15 minutes later was 120 mg/dL. She reported similar symptoms in the last 5 years happening “every few months” without a predictable pattern; twice with witnessed loss of consciousness. Workup for syncope in the past included normal neurologic, cardiac, and tilt-table testing. She had no prior low FSG/BG recorded, no personal history of bariatric surgery or family history of diabetes mellitus and no access to antihyperglycemic medications. Past medical history included ulcerative colitis and medications included sulfasalazine and multivitamins. Pertinent review of systems was negative for weight loss, nausea, and diarrhea. Vital signs were within normal limits. Physical exam was unremarkable. Height was 165 cm, weight 67.8 kg and body mass index 24.9 kg/m2. Blood draw after overnight fast revealed BG of 78 mg/dL, C-peptide 0.7 ng/mL (ref range 0.8–3.5), insulin 10 µIU/mL (3–19), proinsulin <1.6 pmol/L (<8.0), insulin-like growth factor-2 (IGF-2) 339 ng/mL (180–580) and insulin antibody level 10.0 U/mL (0.0–0.4). She was managed conservatively with frequent small meals and patient has continued to do well without recurrence of symptoms. Conclusion: IAS is an exceedingly rare disease entity with about 460 cases described in literature, mostly in patients of Asian descent. Workup for hypoglycemia in non-diabetic patients should include insulin antibody titers to rule out IAS. There appears to be a genetic predisposition to developing IAS in patients with major histocompatibility complex (MHC) genes HLA-DQA1, HLA-DQB1 and HLA-DRB1. It is now being more frequently described in patients of non-Asian descent, particularly those with other autoimmune or plasma cell dyscrasias. It is also associated with drugs containing sulfhydryl groups and viral infections. Treatment should be tailored to severity of disease. Most drug induced IAS resolves after cessation of culprit drug. Conservative management is usually the first step with frequent, low carbohydrate meals with diazoxide or octreotide as adjunctive options. Immunosuppression (high-dose prednisolone or rituximab) and plasma exchanged are reserved severe or refractory cases.

scholarly journals Insulin Autoimmune Syndrome Treated with Plasmapharesis

2020 ◽  
pp. 25-26
Author(s):  
Dr. Kavya Jonnalagadda ◽  
Dr. Praveen. V. Pavithran
Keyword(s):  
Low Dose ◽  
Serum Insulin ◽  
Oral Prednisolone ◽  
Symptomatic Improvement ◽  
Insulin Antibody ◽  
Autoimmune Syndrome ◽  
Dose Oral ◽  
High Insulin ◽  
History Of ◽  
Antibody Titers

A 66-year male with a history of Central Serous Retinopathy presented with recurrent episodes of hypoglycemia. On evaluation, he was found to have insulin-mediated hypoglycemia with serum insulin of 300uIU/ml, C peptide 27.51ng/ml, when the blood glucose was 46mg/dl. High insulin levels above 100uIU/ml, led to suspicion of Autoimmune hypoglycemia and were confirmed by a high anti-insulin antibody titer of 300U/ml. Imaging was negative for Insulinoma. The patient was started on low dose oral prednisolone under ophthalmological monitoring, but as there was no symptomatic improvement, the dose was increased following which there was a flare-up of CSR. The patient was initiated on plasmapheresis following which his hypoglycemia improved with drop in anti-insulin antibody titers to 29U/ml. The patient was maintained on low dose steroids, which were tapered and stopped over the next six months with complete resolution of hypoglycemia and normalization of anti-insulin antibody titers.

scholarly journals Assessment of plasma blood sugar level in first degree relatives of known type 2 diabetes patients: a descriptive study from Maharashtra, India

2020 ◽  
Vol 7 (3) ◽  
pp. 482
Author(s):  
J. K. Deshmukh ◽  
P. Y. Mulay ◽  
Amit G. Naghate ◽  
Anant A. Takalkar
Keyword(s):  
Family History ◽  
Health Check ◽  
Steady Increase ◽  
Diabetic Patients ◽  
Maternal History ◽  
Family History Of Diabetes ◽  
First Degree Relatives ◽  
Increased Risk ◽  
History Of

Background: There is steady increase in the prevalence of diabetes mellitus from 0.73% to current 2.4% in rural and 4.0% to 11.6% in urban areas. Familial clustering of diabetes may support a genetic predisposition to diabetes. With increase in the prevalence of diabetes there is increase in number of first degree relative as well, thus an increased risk of developing diabetes, will also increase. To study the plasma glucose levels in First-degree relatives of family member of type 2 diabetic patients was the objective of the present study.Methods: It is a descriptive observational study with 1020 individuals serially coming to our outpatient Department for Pre-employment Medical Health Check Up Annual Health Check Up were selected. These individuals have been enrolled for the study and their family history of diabetes was noted, their sugar levels and their lipid levels were estimated and their body mass index was calculated. The data thus collected and analyzed with excel.Results: 184 (18%) individuals were FDRs, were as 836 (82%) individuals were Non-FDRs. There were 754 (74%) males [131(17%) FDR and 623(83%) Non-FDR], were as 213 (26%) females [53(20%) FDR and 213(80%) Non-FDR], 61(6%) individuals were having Diabetic Mother, 91(9%) individuals had Diabetic Father and 32(3%) were those in whom both the Parents were Diabetic. It was found that maternal history has strong association for getting abnormal BSL levels as compared to a diabetic father as the RR of 9.82 (95% 4.84 to 19.95) in individuals with mother being diabetic, and RR of 1.54(95% 0.68 to 3.87) of father being diabetic.Conclusions: Family history of diabetes, maternal history of diabetes and history of both the parents having diabetes are risk factors for diabetes in FDRs.

scholarly journals High Prevalence of Toxoplasma gondii Infection in Type I Diabetic Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Qasem Asgari ◽  
Mohammad Hossein Motazedian ◽  
Amir Khazanchin ◽  
Davood Mehrabani ◽  
Shahrbanou Naderi Shahabadi
Keyword(s):  
Family History ◽  
Type I Diabetes ◽  
Positive Family History ◽  
Control Group ◽  
Diabetic Patients ◽  
Type I ◽  
Toxoplasma Infection ◽  
Family History Of Diabetes ◽  
History Of ◽  
Toxoplasma Gondii Infection

Background. Type I diabetes (TΙDM) is a genetic or autoimmune disorder, which may be stimulated by induced immune system components due to the underlying infectious diseases. This study was undertaken to find out any possible association between Toxoplasma gondii infection and TIDM. Materials and Methods. One hundred and eighty-two blood samples were taken from individuals who were referred to outpatient clinics in Shiraz city, Southern Iran, during a 6-month period. The age of type I diabetic subjects ( n = 91 ) and the control group ( n = 91 ) was identical, which were less than 30 years. The sera were examined for IgG and IgM antibodies by ELISA and correlated with epidemiological factors such as age, sex, and family history of diabetes. Results. Out of 91 diabetic patients, 54 (59.3%) were female and 37 (40.7%) were male. The highest frequency of diabetes belonged to 6-10- and 11-15-year groups ( P = 0.17 ). Toxoplasma infection prevalence in diabetic and control groups was 28.6% and 7.7%, respectively ( P = 0.001 ). A significantly positive family history of diabetes was observed between diabetic patients (31 cases, 34.1%) and the control group (3 cases, 3.3%) ( P = 0.01 ). Interestingly, IgG positivity was seen in 13 cases (41.9%) of patients with positive family history of type I diabetes and 13 cases (21.7%) of subjects with no positive family history of type I diabetes ( P = 0.04 ). Conclusion. Our study showed a higher prevalence of Toxoplasma infection in type I diabetes patients. It is likely that the prevalence of TIDM decreases by increasing hygiene and preventing toxoplasmosis.

scholarly journals Sweet Taste Threshold among Medical Students with Family History of Diabetes Mellitus

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Nasya Aisah Latif ◽  
Yulia Sofiatin ◽  
Maya Kusumawati ◽  
Rully Marsis Amirullah Roesli
Keyword(s):  
Diabetes Mellitus ◽  
Medical Students ◽  
Family History ◽  
Sweet Taste ◽  
Diabetic Patients ◽  
Taste Threshold ◽  
Cross Sectional ◽  
Family History Of Diabetes ◽  
Increased Risk ◽  
History Of

Background: Diabetic patients have low sensitivity towards sweet taste, thus consuming more sugar. A young adult with family history of diabetes mellitus (FHD) who lives with diabetic parents may have an increased risk of overconsumption of sugar due to a similar dietary pattern, leading to diabetes. This study aimed to explore the difference in the sweet taste threshold (STT) between students with and without a family history of diabetes mellitus. Methods: This cross-sectional study was conducted in October –November 2018 on Class 2018 medical students living in a student dormitory who were divided into those with family history of diabetes (FHD) and those without it (non-FHD). Family history of diabetes and other known diseases were self-reported. The three-Ascending Forced Choice method was used to determine the sweet recognition threshold. Mann-Whitney analysis was used to compare the sweet taste thresholds between the two groups. Result: A total of 183 subjects participated in this study. The non-FHD group had a higher rank of sweet taste threshold than subjects in the FHD group (94.21 vs 81.16), albeit insignificant (p=0.192). Interestingly, the modes of best estimation threshold (BET) for non-FHD group was than the FHD group (0.067 M vs 0.043 M). Conclusion: The BET for students without family history of diabetes is higher than those with family history of diabetes. It is imperative that low sugar consumption campaign should also aim young people without FHD.

scholarly journals A Longitudinal Study of a Panel of Adipokines and Gestational Diabetes Risk (OR36-01-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Ellen Francis ◽  
Mengying Li ◽  
Stefanie Hinkle ◽  
Jinbo Chen ◽  
Liwei Chen ◽  
...  
Keyword(s):  
Family History ◽  
Gestational Diabetes ◽  
Early Pregnancy ◽  
Predictive Value ◽  
Binding Protein ◽  
Retinol Binding Protein ◽  
Blood Draw ◽  
Fatty Acid Binding ◽  
Family History Of Diabetes ◽  
History Of

Abstract Objectives Prospective studies with measurement of a comprehensive panel of adipokines in early pregnancy and gestational diabetes (GDM) risk are sparse, and studies of adipokines for prediction of GDM are limited. We aimed to prospectively investigate a comprehensive panel of adipokines in relation to GDM risk. Methods We investigated a panel of adipokines in relation to GDM risk. In a nested case-control study within the NICHD Fetal Growth Studies-Singleton cohort (2009–2013), we identified 107 GDM cases and selected 214 controls matched on age, race/ethnicity, and gestational week (GW) at blood draw. Plasma Leptin, Soluble Leptin Receptor (sOB-R), Free Leptin, Chemerin, Fatty Acid Binding Protein 4 (FABP4), Retinol Binding Protein 4, Adiponectin, Omentin1, and Vaspin were measured prior to GDM at GWs 10–14, 15–26. Adjusting for maternal age, GW of blood collection, nulliparity, and family history of diabetes, conditional logistic analysis was performed to estimate adjusted odds ratios (aOR) for associations of adipokines with GDM. Receiver-operating-characteristic (ROC) curves assessed the predictive value of adipokines for GDM diagnosis. Results Before GDM diagnosis, Leptin, Free Leptin, Chemerin, and FABP4 concentrations were significantly higher, and Adiponectin, and sOB-R were lower among cases than controls. At GW 10–14, Adiponectin, and sOB-R were significantly and inversely related to GDM risk. For example, across increasing quartiles of sOB-R the aOR were 1.00 (ref), 0.37 (0.19, 0.74), 0.28 (0.13, 0.59), and 0.24 (0.11, 0.52) (Ptrend ≤ .0001). In contrast, Leptin, Free Leptin, Chemerin, and FABP4 were significantly and positively associated with GDM risk; Ptrend ≤ .0001, ≤.0001, 0.005, 0.004, respectively. In general, associations of adipokines with GDM were stronger at GW 15–26. In addition, at GW 15–26, sOB-R significantly improved GDM prediction over conventional risk factors (age, GW, race, nulliparity, family history of diabetes, prepregnancy BMI) and glucose (P = 0.02). Conclusions A panel of adipokines may be implicated in the pathogenesis of GDM with significant associations and incremental predictive value detected in early pregnancy before GDM is usually screened for. Funding Sources Ellen Francis was supported by the Graduate Partnership Program in the Office of Intramural Training & Education, a component of the National Institutes of Health. Supporting Tables, Images and/or Graphs  

scholarly journals The E23K variant in the Kir6.2 subunit of the ATP-sensitive K+ channel does not augment impaired glucose tolerance in Caribbean subjects with a family history of type 2 diabetes

2005 ◽  
Vol 185 (3) ◽  
pp. 439-444 ◽  
Author(s):  
Chidum Ezenwaka ◽  
Risha Kalloo ◽  
Mathias Uhlig ◽  
Robert Schwenk ◽  
Juergen Eckel
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Family History ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Diabetic Patients ◽  
Family History Of Diabetes ◽  
Control Subjects ◽  
History Of

The E23K variant of the Kir6.2 gene has been shown to be associated with type 2 diabetes mellitus in Caucasian subjects. Because offspring of type 2 diabetic patients have a genetically increased risk of developing diabetes, we sought to identify the E23K variant of the Kir6.2 gene in offspring of Caribbean patients with type 2 diabetes and assess the contribution of this variant to impaired glucose tolerance in these subjects. Forty-six offspring of patients with type 2 diabetes and 39 apparently healthy subjects whose immediate parents were not diabetic (‘control’) were studied after an overnight fast. Anthropometric indices were measured and blood samples were collected. Fasting and 2 h plasma glucose, insulin and lipids were subsequently determined. Insulin resistance was calculated using the homeostatic model assessment technique. The offspring and control subjects had similar frequencies of the E23K polymorphism (52.6 vs 45.5%, P>0.05) and the frequency of the E23K variant did not differ significantly between gender and ethnic distributions, irrespectively of a family history of diabetes (P>0.05). There were no significant differences in biochemical risk factors for developing diabetes in offspring carriers of the E23K variant compared with offspring non-carriers of the mutation. Offspring with the E23K mutation had even significantly higher 2 h insulin concentrations when compared with control subjects. It is concluded that the presence of the Kir6.2 E23K genotype in Caribbean subjects with an immediate positive family history of diabetes does not confer significantly higher levels of biochemical risk factors for the development of type 2 diabetes.

scholarly journals Blood Glucose Changes during Neurosurgery

1979 ◽  
Vol 7 (1) ◽  
pp. 45-49
Author(s):  
Christopher G. Male
Keyword(s):  
Blood Glucose ◽  
Family History ◽  
Body Temperature ◽  
Older Patients ◽  
High Dose ◽  
Family History Of Diabetes ◽  
Induced Hypotension ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
History Of

Blood glucose levels were studied prospectively in 40 patients undergoing elective major craniotomy. A significant (p < 0.01) hyperglycaemic response was noted after scalp infiltration with adrenaline and incision (0.5 mmol/l) and with continued surgery (0.9 mmol/l). Patients aged 50 years and under showed a significantly greater rise with adrenaline and incision than older patients (0.8 compared with 0.4 mmol/l p < 0.01). Preoperative high dose steroid therapy did not modify the response Blood glucose changes were unrelated to sex, obesity, a family history of diabetes, the duration of starvation, intraoperative body temperature, anaesthetic technique induced hypotension or blood loss.

scholarly journals Effect of physical activity on reducing the risk of diabetic retinopathy progression: 10-year prospective findings from the 45 and Up Study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0239214
Author(s):  
Xixi Yan ◽  
Xiaotong Han ◽  
Changfan Wu ◽  
Xianwen Shang ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Lower Risk ◽  
Cox Regression ◽  
Large Cohort ◽  
P Value ◽  
Diabetic Patients ◽  
Family History Of Diabetes ◽  
South Wales ◽  
History Of

Objective To examine the association of physical activities (PA) with diabetic retinopathy (DR) progression based on a 10-year follow-up of a large cohort of working-aged diabetic populations in Australia. Methods Nine thousand and eighteen working-aged diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (<5 sessions/week), medium (≥5–14), and high (≥14) levels. Retinal photocoagulation (RPC) treatment during the follow-up period was used as a surrogate for DR progression and was tracked through the Medicare Benefits Schedule, which was available from 2004 to 2016. Cox regression was used to estimate the association between PA and RPC incidence. Results In the fully adjusted model, higher PA level was significantly associated with a lower risk of RPC incident (Cox-regression, p-value for trend = 0.002; medium vs. low, hazard ratio (HR) = 0.78, 95% Confidence Interval (CI): 0.61–0.98; high vs. low, HR = 0.61, 95%CI: 0.36–0.84. In addition, gender, body mass index, insulin treatment, family history of diabetes, history of cardiovascular disease were significant effect modifiers for the association between PA and RPC. Conclusions Higher PA level was independently associated with a lower risk of DR progression among working-aged diabetic populations in this large cohort study.

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