Recurrent Insulin Autoimmune Syndrome Caused by ¥á-Lipoic Acid in Type 2 Diabetes
¹è»ó¹¬, ¹è¸í³², ±èÀº¿µ, ±èÀϱÔ, ¼¹Î¿ì, ½ÅÁø°æ, Á¶¼º·¡, Jeong Gui-Hwa,
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¹è»ó¹¬ ( Bae Sang-Mook )
Catholic University College of Medicine Department of Internal Medicine
¹è¸í³² ( Bae Myoung-Nam )
Catholic University College of Medicine Department of Internal Medicine
±èÀº¿µ ( Kim Eun-Young )
Catholic University College of Medicine Department of Internal Medicine
±èÀÏ±Ô ( Kim Il-Kyu )
Catholic University College of Medicine Department of Internal Medicine
¼¹Î¿ì ( Seo Min-Woo )
Catholic University College of Medicine Department of Internal Medicine
½ÅÁø°æ ( Shin Jin-Kyeong )
Catholic University College of Medicine Department of Internal Medicine
Á¶¼º·¡ ( Cho Sung-Rae )
Changwon Fatima Hospital Department of Internal Medicine Division of Endocrinology
( Jeong Gui-Hwa )
Changwon Fatima Hospital Department of Internal Medicine Division of Endocrinology
KMID : 0356620130280040326
Abstract
Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia caused by insulin autoantibodies in the absence of exogenous insulin administration. Some drugs containing sulfhydryl compounds are known to initiate the onset of IAS. A 67-year-old female who had diabetes for 5 years visited the outpatient clinic at our institution due to diabetic peripheral polyneuropathy. She was prescribed ¥á-lipoic acid (ALA), which contains two sulfur atoms. Two weeks later, she complained of recurrent hypoglycemic symptoms. We detected a high level of insulin and high titers of insulin autoantibodies. Her human leukocyte antigen (HLA) genotype included the DRB1*0406 allele, which indicates a high level of susceptibility to IAS. She was treated with prednisolone. After this episode, she experienced two more hypoglycemic events after taking ALA for diabetic neuropathy in other hospitals. As ALA can be used to treat diabetic peripheral polyneuropathy, physician discretion is advised based on the possibility of IAS due to ALA in diabetic patients.
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Alpha-lipoic acid; HLA-DRB1*0406 antigen; Insulin antibodies; Insulin autoimmune syndrome
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