[Hypoglycemia due to antibodies to exogenous insulin in a patient with type 2 diabetes – a case report of treatment with new generation oral hypoglycemic agents].

Przeglad lekarski Pub Date : 2017-01-01
Damian Ucieklak, Joanna Zięba-Parkitny, Elżbieta Kozek, Jan Skupień, Krystyna Sztefko, Maciej T Małecki
{"title":"[Hypoglycemia due to antibodies to exogenous insulin in a patient with type 2 diabetes – a case report of treatment with new generation oral hypoglycemic agents].","authors":"Damian Ucieklak,&nbsp;Joanna Zięba-Parkitny,&nbsp;Elżbieta Kozek,&nbsp;Jan Skupień,&nbsp;Krystyna Sztefko,&nbsp;Maciej T Małecki","doi":"","DOIUrl":null,"url":null,"abstract":"<p><p>Hypoglycemic syndromes associated\nwith immune reactions against\ninsulin are rare phenomena described\npredominantly in Asians. Steroid\ntherapy, immunosuppression or plasmapheresis\nis often required.</p><p><strong>Case report: </strong>A 73-year-old White\nwoman with a 20-year history of type\n2 diabetes was admitted to hospital\ndue to recurrent incidents of hypoglycemia\nthat started several months\nafter insulin initiation (lispro 75/25)\nand increased in severity over the\nnext 5 years. They were accompanied\nby postprandial hyperglycemia up\nto 25 mmol/l. The patient’s glycated\nhemoglobin (HbA1c) was 70 mmol/\nmol (8.6%). During hypoglycemic\nepisodes recorded serum C-peptide\nwas 0.57-0.73 nmol/l (1.7-2.2 ng/ml),\nwhile insulin concentration exceeded\n7000 pmol/l (1000 mIU/l). Surreptitious\ninsulin administration was ruled out as\nwas, based on diagnostic imaging, the\npresence of an insulin secreting tumor.\nAnti-insulin antibody (AIA) level measured\nby 125I-insulin binding method was\n92.5% (normal < 8.2%). Hypoglycemic\nepisodes occurred for four days after\ndiscontinuation of insulin therapy\nand then resolved completely. Good\nglycemic control was maintained with\nmetformin, acarbose and dapagliflozin.\nThree months later dapagliflozin was\nreplaced with vildagliptine due to poor\ntolerance of a SGLT-2 inhibitor. Patient’s\nHbA1c was 54 mmol/mol (7.1%),\ntotal fasting insulin level 2577 pmol/l\nand AIA binding 85.9%. Over the next\nyear the patient has not experienced\nhypoglycemia and maintained good\nglycemic control, as HbA1c level was 53\nmmol/l (7.0%) and AIA binding 39.5%.</p><p><strong>Conclusions: </strong>In this rare case of\na patient with diabetes and hypoglycemic\nsyndrome related to AIA, we\nachieved a rapid and stable remission\nof hypoglycemia without immunosuppression.\nGood glycemic control, despite 20-year history\nof diabetes was achieved with oral hypoglycemic agents.</p>","PeriodicalId":21148,"journal":{"name":"Przeglad lekarski","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Przeglad lekarski","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Hypoglycemic syndromes associated with immune reactions against insulin are rare phenomena described predominantly in Asians. Steroid therapy, immunosuppression or plasmapheresis is often required.

Case report: A 73-year-old White woman with a 20-year history of type 2 diabetes was admitted to hospital due to recurrent incidents of hypoglycemia that started several months after insulin initiation (lispro 75/25) and increased in severity over the next 5 years. They were accompanied by postprandial hyperglycemia up to 25 mmol/l. The patient’s glycated hemoglobin (HbA1c) was 70 mmol/ mol (8.6%). During hypoglycemic episodes recorded serum C-peptide was 0.57-0.73 nmol/l (1.7-2.2 ng/ml), while insulin concentration exceeded 7000 pmol/l (1000 mIU/l). Surreptitious insulin administration was ruled out as was, based on diagnostic imaging, the presence of an insulin secreting tumor. Anti-insulin antibody (AIA) level measured by 125I-insulin binding method was 92.5% (normal < 8.2%). Hypoglycemic episodes occurred for four days after discontinuation of insulin therapy and then resolved completely. Good glycemic control was maintained with metformin, acarbose and dapagliflozin. Three months later dapagliflozin was replaced with vildagliptine due to poor tolerance of a SGLT-2 inhibitor. Patient’s HbA1c was 54 mmol/mol (7.1%), total fasting insulin level 2577 pmol/l and AIA binding 85.9%. Over the next year the patient has not experienced hypoglycemia and maintained good glycemic control, as HbA1c level was 53 mmol/l (7.0%) and AIA binding 39.5%.

Conclusions: In this rare case of a patient with diabetes and hypoglycemic syndrome related to AIA, we achieved a rapid and stable remission of hypoglycemia without immunosuppression. Good glycemic control, despite 20-year history of diabetes was achieved with oral hypoglycemic agents.

[1例2型糖尿病患者外源性胰岛素抗体所致低血糖-新一代口服降糖药治疗1例报告]。
与胰岛素免疫反应相关的低血糖综合征是一种罕见的现象,主要发生在亚洲。通常需要类固醇治疗、免疫抑制或血浆清除。病例报告:一名73岁白人女性,有20年2型糖尿病病史,因胰岛素治疗数月后低血糖复发入院(lispro 75/25),并在接下来的5年中病情加重。伴餐后高血糖,最高可达25 mmol/l。患者糖化血红蛋白(HbA1c) 70 mmol/mol(8.6%)。低血糖发作时记录的血清c肽为0.57 ~ 0.73 nmol/l (1.7 ~ 2.2 ng/ml),而胰岛素浓度超过7000 pmol/l (1000 mIU/l)。根据诊断成像,排除了偷偷使用胰岛素的可能性,因为存在胰岛素分泌性肿瘤。125i -胰岛素结合法测定抗胰岛素抗体(AIA)水平为92.5%(正常< 8.2%)。停止胰岛素治疗后4天出现低血糖发作,然后完全消退。使用二甲双胍、阿卡波糖和达格列净维持良好的血糖控制。3个月后,由于SGLT-2抑制剂耐受性差,达格列净被维格列汀取代。患者shba1c为54 mmol/mol(7.1%),总空腹胰岛素水平2577 pmol/陆地AIA结合85.9%。在接下来的一年中,患者没有发生低血糖,血糖控制良好,HbA1c水平为53mmol/l (7.0%), AIA结合39.5%。结论:在这例罕见的糖尿病合并AIA相关低血糖综合征患者中,我们在没有免疫抑制的情况下实现了快速稳定的低血糖缓解。尽管有20年的糖尿病病史,口服降糖药仍能控制良好的血糖。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信