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A type 1 diabetic patient with prolonged fasting hypoglycemia and postprandial hyperglycemia due to insulin autoimmune syndrome like insulin antibodies: Evaluation by Scatchard analysis



A type 1 diabetic patient with prolonged fasting hypoglycemia and postprandial hyperglycemia due to insulin autoimmune syndrome like insulin antibodies: Evaluation by Scatchard analysis



Journal of the Japan Diabetes Society 45(7): 471-476



A 38-year-woman admitted in March 1999 for prolonged fasting hypoglycemia and postprandial hyperglycemia since February 1998 was diagnosed with type 1 diabetes mellitus with ketosis in 1997. She was treated with human insulin and initially well-controlled. 125I-insulin binding was 83% and fasting plasma total IRI 1700 muU/ml. Scatchard analysis of the insulin antibody demonstrated a low affinity constant (0.18X108M-1) and high binding capacity (10X108M) of high-affinity binding sites. Insulin antibody binding was similar to that in insulin autoimmune syndrome. Binding capacity decreased in hypoglycemia more than in hyperglycemia, suggesting that the large amount of insulin bound to the insulin antibody in hyperglycemia was gradually released from the antibody and caused prolonged fasting hypoglycemia due to the large amount of free insulin. We concluded that the patient's fasting hypoglycemia and postprandial hyperglycemia were mainly due to an alteration in insulin pharmacokinetics induced by the insulin-binding antibody.

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Accession: 010105822

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