Endocrine Abstracts

JOINT1181

Introduction: Hypoglycemia is a metabolic emergency that can increase micro and macrovascular complications through glycemic variability. The diagnostic approach differs according to the type of Through this observation, we report a racist cause of hypoglycemia in a type 2 diabetic subject.

Observation: This is a 34-year-old patient with type 1 diabetes since childhood, treated with basal bolus analogues with U100 glargine in the evening and insulin aspart before each meal, who presented in consultation for exploration of refractory hypoglycemia. The patient presented with hypoglycemia at 0.3 g/l, generally in the morning and not felt because of associated dysautonomia. This prompted a blood glucose holter test, which revealed hypoglycemia at dawn and late postprandially. The 1st-line workup for organic damage or autoimmunity was strictly normal, except for antiinsulin AC positivity. This positive assay incriminates first and foremost the type of insulin with an immunogenic effect in type 1 diabetics, a high-risk area. Our attitude was to switch to the least immunogenic and most stable insulin, i.e. degludec, with the result that hypoglycemic episodes disappeared completely.

Discussion and conclusion: Insulin is an immunogenic protein, and this same protein is the main autoantigen responsible for the onset of type 1 diabetes. When administered exogenously, i.e. in insulin-requiring subjects of any type of diabetes, the latter can lead to a pathogenic reaction that is all the more exaggerated when it occurs on a background of autoimmunity. Since the introduction of the latest-generation insulin analogues, the frequency of these reactions has fallen sharply. The use of these insulins should be considered when the etiological search for hypoglycemia is undetermined.