Prolonged fasting hypoglycemia due to insulin antibodies in patient with non-insulin-dependent diabetes mellitus: effect of insulin withdrawal on insulin-antibody-binding kinetics.
Fasting hypoglycemia, which persisted for 3 days after insulin treatment was stopped, occurred in a patient with non-insulin-dependent diabetes mellitus who had inappropriate plasma free-insulin levels (18-25 microU/ml) and extremely high antibody-bound insulin (greater than 20,000 microU/ml) but normal counter-regulatory hormone secretion and plasma C-peptide levels. The amount of antibody-bound insulin decreased in a biphasic pattern over 13 mo of observation with an initial half-life of 35 days and a more gradual decrease with a half-life of 160 days. The number of high-affinity antibody binding sites was virtually identical to the amount of antibody-bound insulin in the patient's plasma. We conclude that the patient's fasting hyperinsulinemia and hypoglycemia were due to release of antibody-bound insulin.
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000276:immunology*; D005215:Fasting; D005260:Female; D006207:Half-Life; D006801:Humans; D007003:Hypoglycemia / Q000276:immunology*; D007330:Insulin Antibodies / Q000378:metabolism / Q000502:physiology*; D007700:Kinetics
D007330:Insulin Antibodies