Insulin autoimmune syndrome: A rare cause of hypoglycemia

Abstract

Insulin autoimmune syndrome (IAS) is a rare cause of hyperinsulinemic hypoglycemia. It is due to autoantibodies to endogenous insulin in person who has never been sensitized to insulin by injections. IAS is a third leading cause of spontaneous hypoglycemia in Japan and it is increasingly being recognized worldwide in non-Asian population. However, we report a case of IAS in Asian male. A certain class of medication called sulfhydryl compounds have been shown to sometimes cause IAS. Recently a compound called alpha lipoic acid (ALA) has been associated with an increased risk of developing IAS. ALA is sometimes used for dieting purposes. We report a case of 36-year-old Indian male presented with symptoms of dizziness and feeling of hunger with sweating, noted to have low blood sugars on multiple occasions. There is a definite history of ALA compound intake as dietary supplements with multivitamins. Subsequently, he was diagnosed as a case of recurrent hypoglycemia from IAS due to ALA intake and managed accordingly.

Insulin Autoimmune Syndrome: A Systematic Review

“…As the name suggests, drug-induced IAS patients have a history of taking insulin-related autoimmune syndrome drugs before onset. Te most common such drugs are methimazole [16,17] and lipoic acid [18][19][20][21][22]. Others include clopidogrel [23][24][25][26], proton pump inhibitors [27] (pantoprazole [8], omeprazole), carbimazole [28], coenzyme Q10 [29], antituberculosis drugs [30], gliclazide [31], captopril [32], loxoprofen sodium [33], and albumin preparations [34], within the preceding week.…”