title: Recurrent Insulin Autoimmune Syndrome Caused by α-Lipoic Acid in Type 2 Diabetes.
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 α-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.
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Sang Mook
authors.initials: SM
authors.lastname: Bae
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Myoung Nam
authors.initials: MN
authors.lastname: Bae
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Il Kyu
authors.initials: IK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Min Woo
authors.initials: MW
authors.lastname: Seo
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Jin Kyeong
authors.initials: JK
authors.lastname: Shin
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Changwon Fatima Hospital, Changwon, Korea.
authors.forename: Sung Rae
authors.initials: SR
authors.lastname: Cho
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Changwon Fatima Hospital, Changwon, Korea.
authors.forename: Gui Hwa
authors.initials: GH
authors.lastname: Jeong
keywords: Alpha-lipoic acid; HLA-DRB1*0406 antigen; Insulin antibodies; Insulin autoimmune syndrome