Insulin autoimmune syndrome induced by exogenous insulin injection: a four-case series

Song, Xiaoxiao; Ren, Yong

doi:10.1186/s12902-019-0482-0

Cited by 13 publications

(13 citation statements)

References 28 publications

(37 reference statements)

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“…Indeed, as mentioned above, it is rare for patients with IAs to manifest short-term drastic blood glucose fluctuations, 18 most of them tend to have hypoglycemia at night and hyperglycemia during the day. 19 Hyperinsulinemia is also one of the clinical manifestations of patients with IAs, 20 but their C-peptide and proinsulin levels may or may not increase. 21 In the present study, as our results are shown in Table 2 , the serum insulin levels of positive patients were just significantly higher than those of IA- patients at 0h and 2h, while no significant difference in C-peptide levels.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of OGTT and Correlation Between the Insulin to C-Peptide Molar Ratio, HOMA-IR, and Insulin Antibodies in T2DM Patients

Hua¹,

Zhang²,

Zhang³

et al. 2022

DMSO

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Purpose The purpose of our study was to analyze the characteristics of OGTT and the correlation between the insulin to C-peptide molar ratio (ICPR), HOMA-IR and insulin antibodies (IAs) in T2DM patients. Patients and Methods A total of 77 T2DM patients were included and divided into the IA+ group (25 patients) and IA- group (52 patients). The values of serum glucose, insulin, and C-peptide testing during 2-h OGTT were summarized comparatively, and ROC was made to analyze the predictive value of ICPR for IAs. Results At each time point of OGTT, there was no significant difference in serum glucose and C-peptide changes (p>0.05). Serum insulin levels in positive patients were elevated or not at different time points of the OGTT but ICPR was significantly different (P<0.05) in the two groups. Spearman correlation coefficient analysis showed that the presence of insulin antibodies was correlated with ICPR, but not with HOMA-IR, and ICPR-2h had a better prediction capacity (AUC=0.735, the optimal cutoff-point=0.11, Se=0.760, Sp=0.635). Conclusion T2DM patients with IAs showed no difference in serum glucose and serum C-peptide changes, but elevated or not insulin levels on the OGTTs, compared with negative patients. ICPR-2h can be a preliminary diagnostic index to timely predict IAs in T2DM patients.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Characteristics of OGTT and Correlation Between the Insulin to C-Peptide Molar Ratio, HOMA-IR, and Insulin Antibodies in T2DM Patients

Hua¹,

Zhang²,

Zhang³

et al. 2022

DMSO

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“…Such antibodies have been identified in over one‐third of Graves disease or chronic hepatitis patients 8 . The antibodies analysed in the present study are insulin‐binding immunoglobulins to endogenous or exogenous insulin, which can develop to bovine, porcine, human or human analogue insulins 9,10 . These differ from autoantibodies to insulin‐producing cells, such as anti‐GAD, ‐IA2 and ‐ZnT8, which are associated with propensity to develop T1D and often decline with increasing T1D duration.…”

Section: Discussionmentioning

confidence: 99%

Insulin antibodies are prevalent in adults with type 1 diabetes referred for islet cell transplantation and are modified by islet transplantation and immunosuppression: an Australian experience

Hensman

Januszewski

Lee

et al. 2022

Internal Medicine Journal

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“…A study by Shen et al 35 found some evidence of high levels of insulin antibodies circulating in the blood of patients who had been diagnosed with diabetes mellitus and were being treated previously with exogenous insulin, potentially leading to a hyperinsulinemia–hypoglycemia state. Furthermore, a high insulin level in states of insulin resistance may result in hypertension due to insulin’s effect on the SNS with the release of catecholamines.…”

Section: Exogenous Hyperinsulinemia and Insulin Antibodymentioning

confidence: 99%

Hyperinsulinemia Associated Depression

Sarwar

Rafiqi

Ahmad

et al. 2022

Clin Med Insights Endocrinol Diabetes

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Hyperinsulinemia promotes fat accumulation, causing obesity. Being an inflammatory state, obesity can induce further inflammation and is a risk factor for HPA (hypothalamic pituitary axis) dysregulation through hypercortisolism-related hyperglycemia. In another hypothesis, the sympathetic nervous system (SNS) plays a significant role in the regulation of hormone secretion from the pancreas such as an increase in catecholamines and glucagon as well as a decrease in plasma insulin levels, a disruption on SNS activity increases insulin levels, and induces glycogenolysis in the liver and lipolysis in adipose tissue during hypoglycemia. Hyperglycemia-hyperinsulinemia exacerbates inflammation and increases the oxidative stress along with regulating the levels of norepinephrine in the brain sympathetic system. Increased inflammatory cytokines have also been shown to disrupt neurotransmitter metabolism and synaptic plasticity which play a role in the development of depression via inhibiting serotonin, dopamine, melatonin, and glutamate signaling. An increased level of plasma insulin over time in the absence of exercising causes accumulation of lipid droplets in hepatocytes and striated muscles thus preventing the movement of glucose transporters shown to result in an increase in insulin resistance due to obesity and further culminates into depression. Further hyperinsulinemia-hyperglycemia condition arising due to exogenous insulin supplementation for diabetes management may also lead to physiological hyperinsulinemia associated depression. Triple therapy with SSRI, bupropion, and cognitive behavioral therapy aids in improving glycemic control, lowering fasting blood glucose, decreasing the chances of relapse, as well as decreasing cortisol levels to improve cognition and the underlying depression. Restoring the gut microbiota has also been shown to restore insulin sensitivity and reduce anxiety and depression symptoms in patients.

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Insulin autoimmune syndrome induced by exogenous insulin injection: a four-case series

Cited by 13 publications

References 28 publications

Characteristics of OGTT and Correlation Between the Insulin to C-Peptide Molar Ratio, HOMA-IR, and Insulin Antibodies in T2DM Patients

Characteristics of OGTT and Correlation Between the Insulin to C-Peptide Molar Ratio, HOMA-IR, and Insulin Antibodies in T2DM Patients

Insulin antibodies are prevalent in adults with type 1 diabetes referred for islet cell transplantation and are modified by islet transplantation and immunosuppression: an Australian experience

Hyperinsulinemia Associated Depression

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