Autoantibodies to the insulin receptor impair clearance of plasma endogenous insulin.
Plasma insulin clearance was studied in a patient with autoantibodies to the insulin receptor, manifesting persistent hyperinsulinemia associated with alternating hyper- and hypoglycemia. In the postabsorptive period, the plasma glucose level gradually decreased. To prevent the development of hypoglycemia, glucose was infused and the glycemic level was clamped at 50 mg/dl without insulin infusion. The plasma C-peptide level was below the detectable range during the clamp, indicating no appreciable secretion of insulin. The plasma insulin level declined exponentially with a markedly prolonged disappearance rate (half-time: 3.0 h) during the study. These results indicate that hyperinsulinemia in the postabsorptive period in this patient is attributable to the impairment of plasma insulin clearance through receptor-mediated mechanisms, and also confirm that the receptor plays the principal role in plasma insulin removal.
Kiyokawa
H
H
Second Department of Internal Medicine, Osaka University Medical School, Japan.
Kono
N
N
Hamaguchi
T
T
Kawachi
M
M
Tajima
K
K
Yamada
Y
Y
Hara
N
N
Mineo
I
I
Kuwajima
M
M
Tarui
S
S
D000052:Acanthosis Nigricans / Q000097:blood / Q000276:immunology*; D001323:Autoantibodies; D001786:Blood Glucose / Q000378:metabolism; D015309:Glucose Clamp Technique; D006801:Humans; D007328:Insulin / Q000097:blood*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D011972:Receptor, Insulin / Q000276:immunology* / Q000378:metabolism
D001323:Autoantibodies; D001786:Blood Glucose; D007328:Insulin; D011972:Receptor, Insulin