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You Cheol Hwang  (Hwang YC) 2 Articles
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
  • 5,201 View
  • 49 Download
  • 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
The Changes in Early Phase Insulin Secretion in Newly Diagnosed, Drug Naive Korean Prediabetes Subjects
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
Korean Diabetes J. 2010;34(3):157-165.   Published online June 30, 2010
DOI: https://doi.org/10.4093/kdj.2010.34.3.157
  • 4,516 View
  • 28 Download
  • 15 Crossref
AbstractAbstract PDFPubReader   
Background

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.

Methods

We 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.

Results

As 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%.

Conclusion

This study suggests that progressive beta cell dysfunction in Koreans may be initiated and rapidly aggravated during the period generally designated as 'normal.'

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
    Xueli Cai, Lili Xia, Yuesong Pan, Dian He, Huiping Zhu, Tiemin Wei, Yan He
    Diabetology & Metabolic Syndrome.2019;[Epub]     CrossRef
  • Effects of Primary Aldosteronism and Different Therapeutic Modalities on Glucose Metabolism
    Mi Kyung Kwak, Jee Yang Lee, Beom-Jun Kim, Seung Hun Lee, Jung-Min Koh
    Journal of Clinical Medicine.2019; 8(12): 2194.     CrossRef
  • Insulin resistance increases the risk of incident type 2 diabetes mellitus in patients with non‐alcoholic fatty liver disease
    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
    Yu-Chieh Chen, Ying-Hua Huang, Jiunn-Ming Sheen, You-Lin Tain, Hong-Ren Yu, Chih-Cheng Chen, Miao-Meng Tiao, Ho-Chang Kuo, Li-Tung Huang
    Pediatrics & Neonatology.2017; 58(2): 135.     CrossRef
  • Insulin Secretory Capacity and Insulin Resistance in Korean Type 2 Diabetes Mellitus Patients
    Jong-Dai Kim, Won-Young Lee
    Endocrinology and Metabolism.2016; 31(3): 354.     CrossRef
  • The effect of glargine versus glimepiride on pancreatic β-cell function in patients with type 2 diabetes uncontrolled on metformin monotherapy: open-label, randomized, controlled study
    Jun Sung Moon, Kyoung Soo Ha, Ji Sung Yoon, Hyoung Woo Lee, Hyun Chul Lee, Kyu Chang Won
    Acta Diabetologica.2014; 51(2): 277.     CrossRef
  • Association of Obstructive Sleep Apnea and Glucose Metabolism in Subjects With or Without Obesity
    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
    C.‐H. Kim, H.‐K. Kim, E. H. Kim, S. J. Bae, J.‐Y. Park
    Diabetic Medicine.2013; 30(9): 1075.     CrossRef
  • Associations among Body Mass Index, Insulin Resistance, and Pancreatic β-Cell Function in Korean Patients with New-Onset Type 2 Diabetes
    Jin Ook Chung, Dong Hyeok Cho, Dong Jin Chung, Min Young Chung
    The Korean Journal of Internal Medicine.2012; 27(1): 66.     CrossRef
  • High normal HbA1c levels were associated with impaired insulin secretion without escalating insulin resistance in Japanese individuals: the Toranomon Hospital Health Management Center Study 8 (TOPICS 8)
    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
    Sang Youl Rhee, Jeong-Taek Woo
    Diabetes & Metabolism Journal.2011; 35(2): 107.     CrossRef
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    Y.-H. Lee, B.-W. Lee, S. W. Chun, B. S. Cha, H. C. Lee
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    Chul-Hee Kim
    Korean Diabetes Journal.2010; 34(3): 154.     CrossRef

Diabetes Metab J : Diabetes & Metabolism Journal