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Moon Chan Choi  (Choi MC) 1 Article
Autoimmune Hypoglycemia in a Patient with Characterization of Insulin Receptor Autoantibodies
Suk Chon, Moon Chan Choi, Yun Jung Lee, You Cheol Hwang, In-Kyung Jeong, Seungjoon Oh, Kyu Jeung Ahn, Ho Yeon Chung, Jeong-Taek Woo, Sung-Woon Kim, Jin-Woo Kim, Young Seol Kim
Diabetes Metab J. 2011;35(1):80-85.   Published online February 28, 2011
DOI: https://doi.org/10.4093/dmj.2011.35.1.80
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  • 19 Crossref
AbstractAbstract PDFPubReader   
Background

Type B insulin resistance syndrome is a manifestation of autoantibodies to the insulin receptor that results in severe hyperglycemia and acanthosis nigricans. However, the mechanisms by which these autoantibodies induce hypoglycemia are largely unknown. In this paper, we report the case of patient with type B insulin resistance syndrome who presented with frequent severe fasting hypoglycemia and acanthosis nigricans.

Methods

To evaluate the mechanism of hypoglycemia, we measured the inhibition of insulin binding to erythrocytes and IM9 lymphocytes in a sample of the patient's dialyzed serum before and after immunosuppressive therapy.

Results

In the patient's pre-treatment serum IgG, the binding of 125I-insulin to erythrocytes was markedly inhibited in a dose-dependent manner until the cold insulin level reached 10-9 mol/L. We also observed dose-dependent inhibition of insulin binding to IM9 lymphocytes, which reached approximately 82% inhibition and persisted even when diluted 1:20. After treatment with glucocorticoids, insulin-erythrocyte binding activity returned to between 70% and 80% of normal, while the inhibition of insulin-lymphocyte binding was reduced by 17%.

Conclusion

We treated a patient with type B insulin resistance syndrome showing recurrent fasting hypoglycemia with steroids and azathioprine. We characterized the patient's insulin receptor antibodies by measuring the inhibition of insulin binding.

Citations

Citations to this article as recorded by  
  • Systematic Review—Type B Insulin Resistance With Isolated Hypoglycemia and Suppressed Insulin
    Natasha Brown, Marianne S Elston
    The Journal of Clinical Endocrinology & Metabolism.2024; 109(4): 936.     CrossRef
  • Type B insulin resistance syndrome: a systematic review
    Luizianne Mariano Martins, Virgínia Oliveira Fernandes, Manuela Montenegro Dias de Carvalho, Daniel Duarte Gadelha, Paulo Cruz de Queiroz, Renan Magalhães Montenegro
    Archives of Endocrinology and Metabolism.2020;[Epub]     CrossRef
  • Autoimmune hypoglycemia
    Marina Y. Yukina, Diana A. Davtyan, Ekaterina A. Troshina, Nurana F. Nuralieva
    Obesity and metabolism.2018; 15(3): 9.     CrossRef
  • Unique pharmacology of a novel allosteric agonist/sensitizer insulin receptor monoclonal antibody
    Simon A. Hinke, Anne M. Cieniewicz, Thomas Kirchner, Katharine D'Aquino, Rupesh Nanjunda, Jason Aligo, Robert Perkinson, Philip Cooper, Ken Boayke, Mark L. Chiu, Steve Jarantow, Eilyn R. Lacy, Yin Liang, Dana L. Johnson, Jean M. Whaley, Russell B. Lingham
    Molecular Metabolism.2018; 10: 87.     CrossRef
  • Combined Immunosuppressive Therapy Induces Remission in Patients With Severe Type B Insulin Resistance: A Prospective Cohort Study
    Joanna Klubo-Gwiezdzinska, Maria Lange, Elaine Cochran, Robert K. Semple, Cornelia Gewert, Rebecca J. Brown, Phillip Gorden
    Diabetes Care.2018; 41(11): 2353.     CrossRef
  • Hypoinsulinemic Hypoglycemia Followed By The Onset Of Severe Insulin Resistance With Hyperglycemia And Circulating Anti-Insulin Receptor Antibodies In A Patient Suffering Systemic Lupus Erythematosus: A Case Report And Literature Review
    Guillermo Martínez de Pinillos, Mariana Tomé, María M. Viloria, Joaquín Bobillo, María V. Cózar
    AACE Clinical Case Reports.2017; 3(3): e284.     CrossRef
  • The treatment of hyperinsulinemic hypoglycaemia in adults: an update
    M. V. Davi′, A. Pia, V. Guarnotta, G. Pizza, A. Colao, A. Faggiano
    Journal of Endocrinological Investigation.2017; 40(1): 9.     CrossRef
  • Immunosuppressive Therapy in Treatment of Refractory Hypoglycemia in Type B Insulin Resistance: A Case Report
    Lavanya Viswanathan, Imali Sirisena
    Journal of the Endocrine Society.2017; 1(12): 1435.     CrossRef
  • 反復する低血糖発作を契機に発見されたインスリン受容体異常症B型の1例(A case of type B insulin resistance presenting as recurrent hypoglycemia)
    杉本 龍 (Ryu Sugimoto), 髙木 誠 (Makoto Takaki), 前原 潤一 (Junichi Maehara), 具嶋 泰弘 (Yasuhiro Gushima)
    Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine.2017; 28(3): 100.     CrossRef
  • Type B insulin resistance syndrome
    Devina L. Willard, Mary Stevenson, Devin Steenkamp
    Current Opinion in Endocrinology, Diabetes & Obesity.2016; 23(4): 318.     CrossRef
  • Antibody-Mediated Insulin Resistance: When Insulin and Insulin Receptor Act as Autoantigens in Humans
    Christelle Liminet, Julien Vouillarmet, Karim Chikh, Emmanuel Disse
    Canadian Journal of Diabetes.2016; 40(5): 462.     CrossRef
  • The insulin autoimmune syndrome (IAS) as a cause of hypoglycaemia: an update on the pathophysiology, biochemical investigations and diagnosis
    Adel A.A. Ismail
    Clinical Chemistry and Laboratory Medicine (CCLM).2016; 54(11): 1715.     CrossRef
  • Type B insulin-resistance syndrome presenting as autoimmune hypoglycemia, associated with systemic lupus erythematosus and interstitial lung disease
    Seon Mee Kang, Heung Yong Jin, Kyung Ae Lee, Ji Hyun Park, Hong Sun Baek, Tae Sun Park
    The Korean Journal of Internal Medicine.2013; 28(1): 98.     CrossRef
  • Treatment of recurrent hypoglycemia with plasmapheresis and steroid in nondiabetic patient
    Mustafa Kulaksızoglu, Mustafa Sait Gonen, Levent Kebapcilar, Fatih Sahin, Fatih Demirci, Ali Topcu
    Transfusion and Apheresis Science.2013; 48(1): 11.     CrossRef
  • A Case of Persistent Hypoglycemia: When to Think Outside the Box
    Yogeswari Venugopal, Shireene Vethakkan, Sargunan Sockalingam, Raja Jasmin, Karen Choong
    Clinical Diabetes.2013; 31(3): 130.     CrossRef
  • The effect of hyperglycemia and hypoglycemia on glucose transport and expression of glucose transporters in human lymphocytes B and T: An in vitro study
    Bożenna Oleszczak, Leszek Szablewski, Monika Pliszka
    Diabetes Research and Clinical Practice.2012; 96(2): 170.     CrossRef
  • The effect of glucose concentrations in the medium on expression of insulin receptors in human lymphocytes B and T: anin vitrostudy
    Bożenna Oleszczak, Leszek Szablewski, Monika Pliszka
    Journal of Receptors and Signal Transduction.2012; 32(5): 263.     CrossRef
  • Fulminant Type 1 diabetes in a pregnant woman as an initial manifestation of the insulin autoimmune syndrome
    H. S. Kim, T.‐Y. Lee, E. Y. Kim, J. H. Choi, S. Y. Kim, Y.‐C. Hwang, J.‐H. Kang, K. J. Ahn, H. Y. Chung, I.‐K. Jeong
    Diabetic Medicine.2012; 29(10): 1335.     CrossRef
  • A Case of the Type B Insulin Resistance Syndrome with Chronic Hepatitis B
    Hyun Seok Choi, Byoung Ho Choi, Seok Hoo Jeong, Shung Han Choi, Dong Su Shin, Sei hyun Kim, Young Sil Eom, Sihoon Lee, Yeun Sun Kim, Ie Byung Park, Ki Young Lee
    Endocrinology and Metabolism.2011; 26(4): 360.     CrossRef

Diabetes Metab J : Diabetes & Metabolism Journal