Use of the continuous glucose monitoring system to treat insulin autoimmune syndrome: quantification of glucose excursions and evaluation of treatment efficacy

Philippon, Marc J.; Sejil, S.; Mugnier, Monica R.; Rocher, L.; Guibergia, C.; Vialettes, B.; Delenne, B.

doi:10.1111/dme.12418

Cited by 25 publications

(18 citation statements)

References 17 publications

(32 reference statements)

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“…We have expanded the trigger list (Table 3) with a new trigger, thiocolchicoside. Postmeal paradoxical hyperglycaemia followed by post‐absorptive hypoglycaemia was seen in one case which is also described in previous studies …”

Section: Discussionsupporting

confidence: 85%

Management of Insulin Autoimmune Hypoglycaemia: Single‐centre experience from Western India with systematic review of world literature

Patel

Shah

Ramteke-Jadhav

et al. 2020

Clinical Endocrinology

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Background: Awareness about Insulin Autoimmune Hypoglycaemia (IAH) and its management remains limited. Methodology:We describe two cohorts: Cohort 1 (n = 7) included patients with IAH from a tertiary care centre in India and Cohort 2 (n = 294) included systematic review of published English literature from PubMed. They were compared with our insulinoma patients (n = 41). Results: Cohort 1 included seven female patients where two had drugs (carbimazole and thiocolchicoside) as triggering factors. Except for one patient requiring oral prednisolone, others had spontaneous remission. The unique features from our series are being first case series of IAH from India and reporting of second case of thiocolchicoside triggered IAH.Cohort 2 had 294 patients identified from 149 publications. Mean age was 54 ± 19 years. Thirty-five different triggers were identified from 160 cases.Antithyroid drugs were most common triggers in Japanese patients and most common HLA allele was DRB1*0406, while it was alpha-lipoic acid and HLA DRB1*0403 in non-Asians. Serum Insulin >100 µIU/mL and insulin to C-peptide molar ratio (ICMR) >0.25 had specificity of 100% and 97.5%, respectively, for IAH as compared to insulinoma. 56% patients had remission with complex carbohydrate diet and trigger removal while 43% required immunosuppressants. 70% achieved remission within 6 months. Conclusions:Middle age remains most common age group. Sulfhydryl drugs are most common triggers. Serum Insulin >100 µIU/mL and ICMR > 0.25 in critical sample are good predictors for diagnosis of IAH, which needs to be confirmed by IAA.Conservative management with dietary modification and trigger removal usually suffices in majority. Rests need immunosuppressants. K E Y W O R D Scase series of IAH, insulin auto-antibodies, insulin autoimmune hypoglycaemia, insulin autoimmune syndrome, management of IAH, systematic review of IAH

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Section: Discussionsupporting

confidence: 85%

Management of Insulin Autoimmune Hypoglycaemia: Single‐centre experience from Western India with systematic review of world literature

Patel

Shah

Ramteke-Jadhav

et al. 2020

Clinical Endocrinology

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“…Although a spontaneous improvement of the symptoms was reported in the literature [4], most patients were treated di erently by various investigators [4]. Management of IAS as reported by di erent case reports included using di erent immunosuppressive regimens, such as prednisolone [12], hydrocortisone [13], cyclophosphamide [14], azathioprine [15], rituximab [16], mycophenolate mofetil [17], and plasmapheresis [18,19]. Our patient had a complete recovery a er 8-weeks course of prednisolone, although many case reports documented a recovery period a er 12-weeks of prednisolone [20,21].…”

Section: Discussionmentioning

confidence: 99%

Insulin Autoimmune Syndrome in a 25-Year-Old, Previously Healthy Kuwaiti Man

Alrashidi

Alessa²

2019

Case Reports in Endocrinology

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Insulin autoimmune syndrome (IAS) is a disease characterized by hyperinsulinaemic hypoglycaemia associated with autoantibodies against endogenous insulin. We have described a case of a 25-year-old, previously healthy Kuwaiti man who was admitted to the Mubarak Al-Kabeer hospital with a history of recurrent hypoglycaemia. e patient revealed that he had taken several di erent injectable anabolic steroids and growth hormone with oral amino acids and other tablets (fat burners) for bodybuilding in the last two months. He denied knowingly using insulin or insulin analogues. e patient had elevated fasting insulin level (>301 uIU/mL) and elevated insulin autoantibodies (>100.0 IU/mL). A er appropriate work-up, he was diagnosed with IAS. A er treatment with prednisolone (1 mg/kg/day), the patient had complete recovery. In patients with repeated hypoglycaemia, IAS should be considered in the di erential diagnosis. Glucocorticoid therapy can be e ective for the treatment of hypoglycaemia in patients with IAS.

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“…In conclusion, new informative cases of IAS in Caucasians continued to appear in the world literature [27,28,69,70,75,[90][91][92][93][94][95][96][97][98][99]. The very wide range of their clinical presentations and biochemical findings re-emphasised that IAS is a highly heterogeneous syndrome.…”

Section: Comments and Conclusionmentioning

confidence: 99%

The insulin autoimmune syndrome (IAS) as a cause of hypoglycaemia: an update on the pathophysiology, biochemical investigations and diagnosis

Ismail¹

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:Insulin autoimmune syndrome (IAS) is considered to be very rare in Caucasians. Understanding its pathophysiology is paramount in (a) appreciating its potential impact on analyses of pancreatic hormones and (b) explaining its highly variable clinical manifestations in non-diabetic, non-acutely ill patients with indeterminate hypoglycaemia. The underlying aetiology of IAS is the presence of variable affinity/avidity endogenous insulin antibodies in significant amounts. The two types of insulin antibodies namely antibodies which bind insulin and/ or proinsulin(s) and receptor antibodies (insulin mimetic) will be discussed. Their biochemical and immunological roles in causing hypoglycaemia will be highlighted. Clinical manifestations of IAS can vary from mild and transient to spontaneous, severe and protracted hypoglycaemia necessitating in extreme cases plasmapheresis for glycaemic control. Antibodies of IAS can interfere in pancreatic immunoassay tests causing erroneous and potentially misleading results. Thorough testing for endogenous insulin antibodies must be considered in the investigations of non-diabetic, non-acutely ill patients with indeterminate and/or unexplained hypoglycaemia.Keywords: endogenous insulin antibodies; Hirata's disease, insulin autoimmune hypoglycaemia; hypoglycaemia in non-diabetic; insulin autoimmune syndrome (IAS); interference in immunoassays of insulin, proinsulin and C-peptide; wrong immunoassay results .

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Use of the continuous glucose monitoring system to treat insulin autoimmune syndrome: quantification of glucose excursions and evaluation of treatment efficacy

Cited by 25 publications

References 17 publications

Management of Insulin Autoimmune Hypoglycaemia: Single‐centre experience from Western India with systematic review of world literature

Management of Insulin Autoimmune Hypoglycaemia: Single‐centre experience from Western India with systematic review of world literature

Insulin Autoimmune Syndrome in a 25-Year-Old, Previously Healthy Kuwaiti Man

The insulin autoimmune syndrome (IAS) as a cause of hypoglycaemia: an update on the pathophysiology, biochemical investigations and diagnosis

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