Recurrent Insulin Autoimmune Syndrome Caused by alpha-Lipoic Acid in Type 2 Diabetes.
10.3803/EnM.2013.28.4.326
- Author:
Sang Mook BAE
1
;
Myoung Nam BAE
;
Eun Young KIM
;
Il Kyu KIM
;
Min Woo SEO
;
Jin Kyeong SHIN
;
Sung Rae CHO
;
Gui Hwa JEONG
Author Information
1. Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
- Publication Type:Case Report
- Keywords:
Alpha-lipoic acid;
HLA-DRB1*0406 antigen;
Insulin antibodies;
Insulin autoimmune syndrome
- MeSH:
Aged;
Alleles;
Ambulatory Care Facilities;
Autoantibodies;
Diabetic Neuropathies;
Female;
Genotype;
Humans;
Hypoglycemia;
Insulin Antibodies;
Insulin*;
Leukocytes;
Polyneuropathies;
Prednisolone;
Sulfhydryl Compounds;
Sulfur;
Thioctic Acid*
- From:Endocrinology and Metabolism
2013;28(4):326-330
- CountryRepublic of Korea
- Language:English
-
Abstract:
Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia caused by insulin autoantibodies in the absence of exogenous insulin administration. Some drugs containing sulfhydryl compounds are known to initiate the onset of IAS. A 67-year-old female who had diabetes for 5 years visited the outpatient clinic at our institution due to diabetic peripheral polyneuropathy. She was prescribed alpha-lipoic acid (ALA), which contains two sulfur atoms. Two weeks later, she complained of recurrent hypoglycemic symptoms. We detected a high level of insulin and high titers of insulin autoantibodies. Her human leukocyte antigen (HLA) genotype included the DRB1*0406 allele, which indicates a high level of susceptibility to IAS. She was treated with prednisolone. After this episode, she experienced two more hypoglycemic events after taking ALA for diabetic neuropathy in other hospitals. As ALA can be used to treat diabetic peripheral polyneuropathy, physician discretion is advised based on the possibility of IAS due to ALA in diabetic patients.
