Endocrine Abstracts

Introduction: Diabetes is a chronic, progressive disease characterized by elevated levels of blood glucose. In type 1 diabetes, some patients experience a “honeymoon period” shortly after diagnosis, wherein insulin needs decrease significantly and a few studies have demonstrated that drug-free glycemic control can be achieved in type 2 diabetes. We describe 2 unusual cases of endogenous hyperinsulinism and diabetes remission.

Case presentation 1: A 24 year-old female who was admitted to the hospital for hypoglycemia. She was diagnosed with type 1 diabetes at the age of 17 after an episode of Diabetic Ketoacidosis. She was treated with insulin for 6 years. During the last year, she experienced recurrent episodes of hypoglycemia that have persisted regardless of the progressive withdrawal of insulin therapy with no episodes of hyperglycemia. In the first 48 hours of glycemic control in hospital care, a symptomatic hypoglycemia was documented and a blood sample showed that her plasma glucose was 62 mg/dl, insulin level was 3,3 μUI/ml and C-peptid was 1,04 ng/ml. These levels confirmed endogenous hyperinsulinism.

Case presentation 2: A 43 year-old female who was referred to our hospital for evaluation of recurrent episodes of hypoglycemia. She was discovered having diabetes mellitus at the age of 33 and treated with insulin for the last 10 years. During the last year, she continued to have frequent hypoglycemic episodes, despite repeated dose reductions and finally she stopped the insulin therapy. Two months later, her fasting plasma glucose was 2.4 mmol/l. On admission, A blood sample showed that her plasma insulin level was 24.1 μIU/ml, C-peptide was 0.43 ng/ml and cortisol was 49 nmol/l, while glucose level was 33 mg/dl. These levels were consistent with endogenous hyperinsulinism.

Conclusion: These cases highlight the possibility of diabetes remission induced by endogenous hyperinsulinism. Diabetes remission after years of insulin therapy is uncommon and it should be investigated thoroughly.