Endocrine Abstracts

Introduction: Hypoglycemia is rarely due to an auto-immune etiology, which is the presence in the serum of the patient of anti-insulin or anti-insulin receptor antibodies. The present case is of a slow type 1 diabetic patient in whom the autoimmune origin of repeated hypoglycemia was found.

Case: A 58 years old female patient, Who is a slow type 1 diabetes carrier, and has been on premixed human insulin for 4 years, the patient presented repeated episodes of hypoglycemia: both nocturnal and late postprandial. She also denied skipping meals or having any drug intake that is likely to cause hypoglycemia, the search for signs in favor of gastroparesis was negative, and no family history of Autoimmune disease was found. Physical Examination revealed a conscious patient, glucose blood level was 0,6 g/l, No lipodystrophy was found. Blood tests showed normal liver and kidney function, Cortisol level at 8 AM was 15 μg / dl; after stimulation (Synacthen test): 26 μg / dl, Anti-transglutaminase IgA antibody detection was negative with absence of IgA deficiency), High levels of anti-insulin antibodies was discovered; it returned higher than 50 IU/ml, The diagnosis of autoimmune hypoglycemia was confirmed by the high level of the Anti-insulin antibodies. The indication for corticosteroid therapy was made alongside the use of the insulin analogue.

Conclusion: Autoimmune hypoglycemia is considered a rare etiology of hypoglycemia, human insulin remains as an immunogenic product that induces the secretion of specific antibodies, especially among patients with autoimmune diseases.