Insulin autoimmunity and hypoglycemia in seven white patients

Ananda Basu, F. John Service, Liping Yu, Don Heser, Laura M. Ferries, George Eisenbarth

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objective: To report the clinical, biochemical, and immunologic characteristics of 7 white patients with the rare disorder of hyperinsulinemic hypoglycemia in association with spontaneously generated high titers of antibodies to human insulin. Methods: We reviewed the clinical data, history, and symptoms of the 7 study patients and summarized the biochemical findings during a spontaneous episode of hypoglycemia. Insulin antibody binding was measured in all patients, and antibody affinity, capacity, and clonality were analyzed in 4. A mixed meal study was conducted in 2 patients. A potential mechanism for postprandial hypoglycemia is presented. Results: In all 7 patients (6 women and 1 man), symptoms were neuroglycopenic, occurring primarily postprandially but during fasting in some patients. During hypoglycemia, concentrations of insulin, proinsulin, and, in most patients, C peptide considerably exceeded those observed in patients with insulinoma. These concentrations were spuriously elevated as a result of interference by the autoantibodies in the immunoassays. No patient had evidence of an insulinoma on various radiologic localization procedures directed at the pancreas. Insulin antibodies showed a high percentage of binding to human insulin - 50 to 90%. Heterogeneity of antibodies regarding clonality and antibody binding sites was noted; some patients had polyclonal and some had monoclonal IgG class antibodies. Most patients had two categories of binding sites: high affinity/low capacity and low capacity/high affinity. Although the mechanism for postprandial hypoglycemia remains conjectural, prolonged elevations of postprandial concentrations of total and free insulin are consistent with the putative mechanism of a buffering effect of insulin antibodies. Conclusion: Insulin autoimmune hypoglycemia, although rare in any racial group and especially in white subjects, can be readily detected by high titers of insulin antibodies. Such a determination should be done in all patients undergoing evaluation for hypoglycemia.

Original languageEnglish (US)
Pages (from-to)97-103
Number of pages7
JournalEndocrine Practice
Volume11
Issue number2
StatePublished - Mar 2005

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Autoimmunity
Hypoglycemia
Insulin
Insulin Antibodies
Insulinoma
Antibody Binding Sites
Proinsulin
Antibody Affinity
Antibodies
Immunoglobulin Isotypes
C-Peptide
Immunoassay
Autoantibodies
Meals
Pancreas
Fasting
Immunoglobulin G
History
Binding Sites

ASJC Scopus subject areas

  • Endocrinology

Cite this

Basu, A., Service, F. J., Yu, L., Heser, D., Ferries, L. M., & Eisenbarth, G. (2005). Insulin autoimmunity and hypoglycemia in seven white patients. Endocrine Practice, 11(2), 97-103.

Insulin autoimmunity and hypoglycemia in seven white patients. / Basu, Ananda; Service, F. John; Yu, Liping; Heser, Don; Ferries, Laura M.; Eisenbarth, George.

In: Endocrine Practice, Vol. 11, No. 2, 03.2005, p. 97-103.

Research output: Contribution to journalArticle

Basu, A, Service, FJ, Yu, L, Heser, D, Ferries, LM & Eisenbarth, G 2005, 'Insulin autoimmunity and hypoglycemia in seven white patients', Endocrine Practice, vol. 11, no. 2, pp. 97-103.
Basu A, Service FJ, Yu L, Heser D, Ferries LM, Eisenbarth G. Insulin autoimmunity and hypoglycemia in seven white patients. Endocrine Practice. 2005 Mar;11(2):97-103.
Basu, Ananda ; Service, F. John ; Yu, Liping ; Heser, Don ; Ferries, Laura M. ; Eisenbarth, George. / Insulin autoimmunity and hypoglycemia in seven white patients. In: Endocrine Practice. 2005 ; Vol. 11, No. 2. pp. 97-103.
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