Long-Term Prevention of Hypoglycemia by Conservatively Managed Insulin Autoimmune Syndrome

ABSTRACT Objective: Insulin autoimmune syndrome (IAS) is a rare condition with limited case reports in non-Asian populations and uncertain rates of spontaneous remission. This case study highlights durable prevention of hypoglycemia by conservative management of IAS. Methods: We report a New Zealand European female presenting with severe hypoglycemia due to IAS managed with dietary modification and diazoxide. Results: An 82-year-old female was evaluated for unexplained, severe hypoglycemia. Serum insulin titer was markedly elevated, with elevated C-peptide concentration, indicating endogenous production. Subsequent measurement of serum insulin antibodies confirmed IAS. Ongoing hypoglycemic episodes were managed with dietary modification and diazoxide. There were no further episodes of severe hypoglycemia. Insulin antibody titer fell over the following 2 years without further intervention. The patient remained free of hypoglycemic episodes and symptoms. Conclusion: This case report summarizes the rare condition IAS and describes long-term prevention of hypoglycemia and biochemical improvement with conservative management. Abbreviations: HLA = human leukocyte antigen IAS = insulin autoimmune syndrome