Anti-Insulin Antibody Syndrome Following Alpha-Lipoic Acid Use in Turkish Patients: Report of Three New Cases

Abstract

Anti-insulin antibody syndrome is a rare autoimmune disorder that is characterized by severe hypoglycemia, elevated blood insulin level, insulin autoantibodies, and the absence of pancreas islet cell pathology or exogenous insulin exposure. Alpha-lipoic acid is a sulfhydrylcontaining compound that is used to treat diabetic peripheral neuropathy and was first reported as a cause of anti-insulin antibody syndrome in Japan in 2003. In the literature, 17 cases with anti-insulin antibody syndrome following alpha-lipoic acid use have been reported from Japan, along with one case from Turkey, two from Korea, and seven cases from Italy. In this article, we present three cases with anti-insulin antibody syndrome developed after alpha-lipoic acid use. Case 1: A 72-year-old male patient was observed to have lost consciousness at home. This patient had no history of diabetes mellitus, diabetic medication, or insulin use. The patient complained of tiredness, palpitations, and sweating that began 3-4 h after eating but regressed after eating during the past month. The patient had a history of diagnosis with lumbar disk hernia two months ago and was using alpha-lipoic acid (600 mg). Case 2: A 67-year-old diabetic female patient using alpha-lipoic acid (600 mg) following the diagnosis of diabetic peripheral neuropathy. She complained of shivering and sweating two to three hours after a meal that started after starting alpha-lipoic acid therapy. Case 3: A 46-year-old male patient complained of fatigue, palpitations, and sweating for the last three weeks. Seven weeks ago, he started using alpha-lipoic acid (600 mg) after being diagnosed with carpal tunnel syndrome. The patients were diagnosed with anti-insulin antibody syndrome secondary to alpha-lipoic acid use, following which their alpha-lipoic therapy was discontinued. Alpha-lipoic acid is widely used in the treatment of diabetic peripheral neuropathy, nutritional support, or as an anti-aging agent. However, it should be noted that its use may cause anti-insulin antibody syndrome in genetically predisposed people.