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Exogenous insulin antibody syndrome in a patient with diabetes secondary to total pancreatectomy

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Abstract

Exogenous insulin can induce insulin antibodies that have a low affinity/high binding capacity. Similar to what is observed in insulin autoimmune syndrome, these insulin antibodies can cause fasting hypoglycemia and postprandial hyperglycemia, a phenomenon known as “exogenous insulin antibody syndrome” (EIAS). Cases of EIAS in patients with type 1 and type 2 diabetes have been sporadically reported, mainly in Asia. However, there has been no report on EIAS in patients with diabetes secondary to total pancreatectomy treated with insulin analogs. A 74-year-old man with diabetes after total pancreatectomy had been treated with continuous subcutaneous insulin infusion using an insulin analog, lispro, and developed recurrent early morning hypoglycemia even after discontinuation of nocturnal basal insulin. His fasting serum lispro level was high even approximately 9 h after the last lispro dose. He had a high titer (72.7%) of insulin antibodies, and a Scatchard analysis revealed low affinity/high binding capacity. These findings suggested that the patient’s recurrent early morning hypoglycemia was associated with insulin antibodies against lispro, and we, therefore, switched from lispro to another insulin analog, glulisine. His hypoglycemia improved, accompanied by a dramatic decrease in his insulin antibodies and serum glulisine levels. Early morning hypoglycemia in patients with diabetes secondary to total pancreatectomy may often be explained by high glycemic variability, malnutrition, and/or glucagon deficiency. However, in cases of recurrent early morning hypoglycemia, EIAS should be considered as a potential differential diagnosis.

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Acknowledgements

The authors wish to thank Tosoh, Co., Japan, for their assistance in measuring the serum IRI levels using the ST AIA-PACK IRI.

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Authors and Affiliations

  1. Department of Diabetes and Endocrinology, Osaka Police Hospital, 10-31 Kitayama-cho, Tennojiku, Osaka, 543-0035, Japan

    Yoshinari Obata, Kana Takayama, Hideyuki Nishikubo, Aoki Tobimatsu, Izumi Matsuda, Yuhei Uehara, Yumiko Maruo, Hiroyuki Sho, Motohiro Kosugi & Tetsuyuki Yasuda

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  1. Yoshinari Obata
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  2. Kana Takayama
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  3. Hideyuki Nishikubo
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  4. Aoki Tobimatsu
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  5. Izumi Matsuda
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  6. Yuhei Uehara
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  8. Hiroyuki Sho
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  9. Motohiro Kosugi
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  10. Tetsuyuki Yasuda
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Corresponding author

Correspondence to Tetsuyuki Yasuda.

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Compliance with ethical standards

This article does not contain any studies with human or animal subjects performed by any of the authors. The patient provided written informed consent for the publication of this case report.

Conflict of interest

TY received lecture fees from Eli Lilly Japan K.K. The other authors declare that they have no competing interests associated with this case report.

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Obata, Y., Takayama, K., Nishikubo, H. et al. Exogenous insulin antibody syndrome in a patient with diabetes secondary to total pancreatectomy. Diabetol Int 14, 211–216 (2023). https://doi.org/10.1007/s13340-022-00611-z

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  • DOI: https://doi.org/10.1007/s13340-022-00611-z

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