title: Immunological hypoglycemia associated with insulin antibodies induced by exogenous insulin in 11 Chinese patients with diabetes.
abstract: OBJECTIVE
  To investigate the characteristics of immunological hypoglycemia associated with insulin antibodies (IAbs) induced by exogenous insulin in Chinese patients with diabetes.
  
  
  METHODS
  The clinical data of patients with immunological hypoglycemia due to IAbs were retrospectively analyzed by screening patients with diabetes discharged from West China Hospital from 2007 to 2013.
  
  
  RESULTS
  A total of 11 patients (eight men and three women) were identified. Insulin-C-peptide separation was found in all patients via insulin and C-peptide release test. Previous insulin use was ceased after admission and was switched to oral hypoglycemic agents (OHAs) (8/11), lifestyle modification only (2/11), or regular human insulin (1/11). Hypoglycemia was ameliorated after a median of 20 days (interquartile range [IQR], 11-40), while IAbs turned negative after a median of 17 months (IQR, 4-19), and serum immunoreactive insulin (IRI) levels dropped substantially after a median of 22 months (IQR, 9-32) in these cases.
  
  
  CONCLUSIONS
  In insulin-treated patients with unexpected and refractory hypoglycemia even after insulin therapy was gradually reduced or even withdrawn, IAbs induced by exogenous insulin should be considered, and insulin withdrawal might be promptly needed. The course of immunological hypoglycemia was benign and self-limited.
authors.affiliation: Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Quan
authors.affiliation: Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
authors.forename: Huiwen
authors.initials: H
authors.lastname: Tan
authors.affiliation: Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
authors.forename: Qianrui
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
authors.forename: Sheyu
authors.initials: S
authors.lastname: Li
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D002096:C-Peptide / Q000097:blood; D002681:China; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000276:immunology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000276:immunology* / Q000627:therapeutic use; D007330:Insulin Antibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007004:Hypoglycemic Agents; D007328:Insulin; D007330:Insulin Antibodies