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Endocrine Abstracts (2017) 49 EP486 | DOI: 10.1530/endoabs.49.EP486

1Endocrinology Department Hospital Garcia de Orta, Almada, Portugal; 2Clinical Chemistry Department Hospital Garcia de Orta, Almada, Portugal; 3Endocrinology Laboratory IPO Francisco Gentil, Lisboa, Portugal.

Insulin autoimmune syndrome (IAS) is a very rare cause of hypoglycaemia in western countries. One proposed mechanism is anti-insulin antibody capture of prandial insulin followed by the dissociation of insulin from anti-insulin antibody. The first objective was to study the relationship between glucose, insulin and C-peptide during a prolonged glucose load in two patients with active IAS. The second was to study the variation of these parameters between the active and the recovery disease states.

Methods: Two patients with IAS and frequent hypoglycaemic episodes at the time of the first study underwent an extended oral glucose tolerance test with 75 g of glucose (4 h). After apparent clinical and biochemical recovery, the procedure was repeated.

Results: The data observed during the active and recovery states are shown in Table 1.

Table 1
Hyperglycaemia phaseHypoglycaemia phase
StateGlucose Mean peak at 1 h (mg/dl)Ins/c-pep ratio (uU/ng)Glucose Mean peak at 3–4 h (mg/dL)(uU/ng)
Active disease199 (range 187–210)7.052 (range 45–59)13.6
Recovery disease16611.24.9

Active disease state: The insulin/c-peptide ratio increased significantly from hyperglycaemia to hypoglycaemia (P=0.023) even after adjusting for the glucose levels (glycaemia to insulin/c-peptide ratio) (P=0.027).

Recovery disease state: Patient showed a decrease in hyperglycaemia peak with a corresponding increase in the insulin/c-peptide ratio and a decreased insulin/c-peptide ratio during hypoglycaemia phase.

Discussion: During active disease, a lower insulin/c-peptide ratio during hyperglycaemia and the paradoxical increase during hypoglycaemia seem to support the role of insulin antibodies in the disease. During the recovery state, there is a reversal of these ratios supporting an increase in bioavailable insulin with lower antibody titters.

Volume 49

19th European Congress of Endocrinology

Lisbon, Portugal
20 May 2017 - 23 May 2017

European Society of Endocrinology 

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