PMID- 29694001
OWN - NLM
STAT- MEDLINE
DCOM- 20180620
LR  - 20210504
IS  - 0033-2240 (Print)
IS  - 0033-2240 (Linking)
VI  - 74
IP  - 1
DP  - 2017
TI  - [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].
PG  - 41-3
AB  - 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.
FAU - Ucieklak, Damian
AU  - Ucieklak D
FAU - Zieba-Parkitny, Joanna
AU  - Zieba-Parkitny J
FAU - Kozek, Elzbieta
AU  - Kozek E
FAU - Skupien, Jan
AU  - Skupien J
FAU - Sztefko, Krystyna
AU  - Sztefko K
FAU - Malecki, Maciej T
AU  - Malecki MT
LA  - pol
PT  - Case Reports
PT  - Journal Article
PL  - Poland
TA  - Przegl Lek
JT  - Przeglad lekarski
JID - 19840720R
RN  - 0 (Antibodies)
RN  - 0 (Benzhydryl Compounds)
RN  - 0 (Glucosides)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin Lispro)
RN  - 1ULL0QJ8UC (dapagliflozin)
RN  - 9100L32L2N (Metformin)
RN  - T58MSI464G (Acarbose)
SB  - IM
MH  - Acarbose/administration & dosage/*therapeutic use
MH  - Administration, Oral
MH  - Aged
MH  - Antibodies/blood
MH  - Benzhydryl Compounds/administration & dosage/therapeutic use
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Drug Therapy, Combination
MH  - Female
MH  - Glucosides/administration & dosage/therapeutic use
MH  - Humans
MH  - Hypoglycemia/*drug therapy
MH  - Hypoglycemic Agents/therapeutic use
MH  - Insulin Lispro/immunology/therapeutic use
MH  - Metformin/administration & dosage/*therapeutic use
EDAT- 2017/01/01 00:00
MHDA- 2018/06/21 06:00
CRDT- 2018/04/26 06:00
PHST- 2018/04/26 06:00 [entrez]
PHST- 2017/01/01 00:00 [pubmed]
PHST- 2018/06/21 06:00 [medline]
PST - ppublish
SO  - Przegl Lek. 2017;74(1):41-3.