- Autoimmune Hypoglycemia in a Patient with Characterization of Insulin Receptor Autoantibodies
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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
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Diabetes Metab J. 2011;35(1):80-85. Published online February 28, 2011
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DOI: https://doi.org/10.4093/dmj.2011.35.1.80
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- 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. MethodsTo 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. ResultsIn 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%. ConclusionWe 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.
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- 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
- The Changes in Early Phase Insulin Secretion in Newly Diagnosed, Drug Naive Korean Prediabetes Subjects
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Sang Youl Rhee, Joo Young Kim, Suk Chon, 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
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Korean Diabetes J. 2010;34(3):157-165. Published online June 30, 2010
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DOI: https://doi.org/10.4093/kdj.2010.34.3.157
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5,320
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There have been no systematic observations regarding changes in early phase insulin secretion among Korean prediabetes and early stage type 2 diabetes mellitus (T2DM) patients. MethodsWe conducted 75-g oral glucose tolerance tests (OGTT) in 873 subjects with suspected abnormal glucose tolerance. All subjects were diagnosed as having normal glucose tolerance (NGT), prediabetes (preDM), or T2DM according to the OGTT results and the insulin secretory and insulin resistance indices of each subject were calculated. Additionally, we analyzed the changes in early phase insulin secretion according to changes in fasting (Glc0), post-prandial (Glc120) glucose and HbA1c (A1c) levels. ResultsAs compared to subjects with NGT, the insulin secretory indices of the preDM and T2DM subjects progressively declined, and the insulin resistance indices were progressively aggravated. Early phase insulin secretion decreased rapidly according to the increments of Glc0, Glc120 and A1c, and these changes were most prominent in the NGT stage. Compared to the control group, the early phase insulin secretion levels of the preDM or T2DM subjects were less than 50% when Glc0 was over 100 mg/dL, Glc120 was over 145 mg/dL, and A1c was over 5.8%. ConclusionThis study suggests that progressive beta cell dysfunction in Koreans may be initiated and rapidly aggravated during the period generally designated as 'normal.'
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Citations
Citations to this article as recorded by 
- Hospital-Based Korean Diabetes Prevention Study: A Prospective, Multi-Center, Randomized, Open-Label Controlled Study
Sang Youl Rhee, Suk Chon, Kyu Jeung Ahn, Jeong-Taek Woo Diabetes & Metabolism Journal.2019; 43(1): 49. CrossRef - Differential role of insulin resistance and β-cell function in the development of prediabetes and diabetes in middle-aged and elderly Chinese population
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Yuya Seko, Yoshio Sumida, Saiyu Tanaka, Kojiroh Mori, Hiroyoshi Taketani, Hiroshi Ishiba, Tasuku Hara, Akira Okajima, Atsushi Umemura, Taichiro Nishikawa, Kanji Yamaguchi, Michihisa Moriguchi, Kazuyuki Kanemasa, Kohichiroh Yasui, Shunsuke Imai, Keiji Shim Hepatology Research.2018;[Epub] CrossRef - Longitudinal Changes in Insulin Resistance, Beta-Cell Function and Glucose Regulation Status in Prediabetes
Chul-Hee Kim, Hong-Kyu Kim, Eun-Hee Kim, Sung-Jin Bae, Jaewon Choe, Joong-Yeol Park The American Journal of the Medical Sciences.2018; 355(1): 54. CrossRef - Prenatal Dexamethasone Exposure Programs the Development of the Pancreas and the Secretion of Insulin in Rats
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Nan Hee Kim, Nam H. Cho, Chang-Ho Yun, Seung Ku Lee, Dae Wui Yoon, Hyun Joo Cho, Jae Hee Ahn, Ji A. Seo, Sin Gon Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Chol Shin Diabetes Care.2013; 36(12): 3909. CrossRef - Relative contributions of insulin resistance and β‐cell dysfunction to the development of Type 2 diabetes in Koreans
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Y. Heianza, Y. Arase, K. Fujihara, H. Tsuji, K. Saito, S. D. Hsieh, S. Kodama, H. Shimano, N. Yamada, S. Hara, H. Sone Diabetic Medicine.2012; 29(10): 1285. CrossRef - The Prediabetic Period: Review of Clinical Aspects
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