Introduction: Hypoglycemia is a severe complication of diabetes mellitus characterized by blood sugar levels lower than 0.7 g/L in individuals with diabetes. Several symptoms can be related to hypoglycemia and severe cases can be lethal. Individuals with type 1 diabetes and on insulin therapy may also experience hypoglycemic episodes but their frequency and late occurrence might indicate the presence of autoantibodies to insulin, if no other causes suggest otherwise. This condition is referred to as Autoimmune hypoglycemia in type 1 diabetes mellitus.
Case report: A 26-year-old woman known to have had type 1 diabetes for 13 years has been on Functional Insulin Therapy (FIT) with NPH and Actratpid based on her food (carbohydrate) intake. Laboratory investigations revealed diabetic nephropathy treated with a perindropil dose of 2.5 mg once daily, autonomic neuropathy with signs of gastroparesis, diabetic peripheral neuropathy with a DN4 score at least 6/10, but there are no signs of diabetic retinopathy at the back of the eye (retina) and her HbA1c level is 7.4%. The patient has been hospitalized with a 6-month history of recurrent hypoglycemic episodes reported to occur almost everyday between 2 and 3 in the morning and characterized by blood sugar levels as low as 0.20 g/l sometimes, requiring oral glucose administration.
Conclusion: It is important to note in this case report that the autoimmune origin of hypoglycemia in individuals with type 1 diabetes is a rare case and that other possible causes should be ruled out in the first place. However, in the context of autoimmunity the abnormal recurrence of hypoglycemic episodes, the human insulin immunogenicity are strong indicators of autoimmune hypoglycemia, and must in addition be confirmed by high levels of antibodies, after a thorough laboratory investigation on the origins of hypoglycemia in the patient.
18 - 21 May 2019
European Society of Endocrinology