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Letters: Comments and Responses

Autoimmune Hypoglycemia in a Type 2 Diabetic Patient With Anti-Insulin and Insulin Receptor Antibodies

Response to Kim et al.

  1. Mustafa Sahin, MD,
  2. Neslihan Tutuncu, MD and
  3. Nilgun Demirag Guvener, MD
  1. From the Department of Endocrinology and Metabolism, Baskent University, Baskent University Hospital, Ankara, Turkey
  1. Address correspondence to Mustafa Sahin, Baskent University, Department of Endocrinology and Metabolism, 5th St., Baskent University Hospital Floor 1, Bahcelievler/Ankara, Turkey. E-mail: drsahinmustafa{at}yahoo.com
Diabetes Care 2004 May; 27(5): 1246-1247. https://doi.org/10.2337/diacare.27.5.1246-a
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Response to Kim et al.

Kim et al. (1) recently reported autoimmune hypoglycemia in a type 2 diabetic patient with anti-insulin and insulin receptor antibodies. The patient was a 72-year-old woman with suitable clinic and laboratory data for autoimmune hypoglycemia. Her plasma glucose was 40 mg/dl, insulin 103.7 μU/ml, and C-peptide 4.1 ng/ml. The authors state, “Patients with this condition have low circulation insulin, C-peptide levels, and refractory hypoglycemia.” We believe that this sentence is discordant with the rest of the letter and patients’ given data.

Hypoglycemia owing to insulin antibodies is rare but should be considered in any patient with hypoglycemia in the setting of nonsuppressed insulin levels, i.e., insulin levels that are markedly elevated, usually >100 μU/ml, as in the given patient (2). Free insulin levels may be normal or high, and C-peptide levels are not suppressed (3).

In hypoglycemia due to insulin receptor antibodies, insulin levels are usually higher than appropriate for the glucose concentration. This finding raises the possibility of a pancreatic tumor (4); however, C-peptide and proinsulin levels are usually appropriately low during hypoglycemia, which helps distinguish the condition from insulinoma.

Footnotes

  • DIABETES CARE

References

  1. ↵
    Kim CH, Park JH, Park TS, Baek HS: Autoimmune hypoglycemia in a type 2 diabetic patient with anti-insulin and insulin receptor antibodies (Letter). Diabetes Care 27:288–289, 2004
    OpenUrlFREE Full Text
  2. ↵
    Redmon JB, Nuttall FQ: Hypoglycemic disorders. Autoimmune Hypoglycemia 8:603–618, 1999
    OpenUrl
  3. ↵
    Burch HB, Clement S, Sokol MS, Landry F: Reactive hypoglycemic coma due to insulin autoimmune syndrome: case report and literature review. Am J Med 92:681–685, 1992
    OpenUrlCrossRefPubMed
  4. ↵
    Taylor SI, Barbetti F, Accili D, Roth J, Gorden P: Syndromes of autoimmunity and hypoglycemia. Endocrinol Metab Clin North Am 18:123–143, 1989
    OpenUrlPubMed
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Diabetes Care: 27 (5)

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May 2004, 27(5)
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Autoimmune Hypoglycemia in a Type 2 Diabetic Patient With Anti-Insulin and Insulin Receptor Antibodies
Mustafa Sahin, Neslihan Tutuncu, Nilgun Demirag Guvener
Diabetes Care May 2004, 27 (5) 1246-1247; DOI: 10.2337/diacare.27.5.1246-a

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Autoimmune Hypoglycemia in a Type 2 Diabetic Patient With Anti-Insulin and Insulin Receptor Antibodies
Mustafa Sahin, Neslihan Tutuncu, Nilgun Demirag Guvener
Diabetes Care May 2004, 27 (5) 1246-1247; DOI: 10.2337/diacare.27.5.1246-a
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  • Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension
  • Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension
  • Flexible Intensive Insulin Therapy in Adults With Type 1 Diabetes and High Risk for Severe Hypoglycemia and Diabetic Ketoacidosis
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