Recurrent Hypoglycemia from Insulin Autoimmune Syndrome
Open accessAbstract
Insulin autoimmune syndrome (IAS) is an uncommon cause of hyperinsulinemic hypoglycemia characterized by autoantibodies to endogenous insulin in individuals without previous exposure to exogenous insulin. IAS is the third leading cause of spontaneous hypoglycemia in Japan, and is increasingly being recognized worldwide in non-Asian populations. We report a case of IAS in a Caucasian woman with recurrent complaints of hypoglycemia, with laboratory findings of serum glucose 2.5 mmol/L (45 mg/dL), insulin 54,930 pmol/L (7,909 μIU/mL), connecting peptide (C-peptide) 4,104 pmol/L (12.4 ng/mL), and a corresponding insulin to C-peptide molar ratio of 13.4 during a spontaneous hypoglycemic event. Autoantibodies to insulin were markedly elevated at > 50 kU/L (> 50 U/mL). IAS should be considered in the differential diagnosis of hypoglycemia in non-diabetic individuals. Distinction from insulinoma is especially crucial to prevent unwarranted invasive procedures and surgical interventions in hypoglycemic patients.
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Uncooked corn starch and small frequent meals with low glycemic index have been found to decrease the frequency of hypoglycemic episodes in IAS.
“Uncooked corn starch and small frequent meals with low glycemic index have been found to decrease the frequency of hypoglycemic episodes [76,77].”
From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [76]
The Case Report (page not provided) says the patient was advised to eat frequent small meals with a low glycemic index and that her hypoglycemic episodes decreased, though they continued during exertion. The Discussion recommends small frequent meals for intractable IAS hypoglycemia. Neither passage reports uncooked corn starch as a treatment, so that part of the claim is unsupported by this paper. (LLM, conf=0.91)
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Han, T., Wang, Z.-Y., Zhou, J., Zhang, N.-H., Li, J.-J., Feng, N., Guo, C., Zhang, W., Li, Y.-Q., Wu, J.-J., et al. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1710461 · Cited by 2 · see citing works
Karkalemis, K., Papadopoulou‐Marketou, N., Kalampokas, E., Simopoulou, M., & Kalampokas, T. (2026) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-025-08245-7
Bottinelli, C. (2021) · doi:10.70675/39383759zc127z4467z9278zf1f03b7d4290
Wang, Y., Liu, Y., Yu, J., Xing, B., Ping, F., Li, W., Xu, L., Li, M., Zhang, H., & Li, Y. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1879250
- Authors
- Wong, S. L., Priestman, A., & Holmes, D. T.
- Affiliations
- University of British Columbia (CA)
- Royal Columbian Hospital (CA)
- Corresponding author
- Wong, Sophia L.
- Venue
- Journal of General Internal Medicine
- Published
- 2013-08-24
- Volume
- 29
- Issue
- 1
- Pages
- 250-254
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC3889959
- OpenAlex
- W1976323398
- Cited by
- 73
- References
- 26
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 7 · 2023: 7 · 2022: 8 · 2021: 7 · 2020: 7 · 2019: 7 · 2018: 8 · 2017: 2 · 2016: 8 · 2015: 2
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- insulin autoimmune syndrome, recurrent hypoglycemia, hyperinsulinemic hypoglycemia, insulin autoantibodies, differential diagnosis of hypoglycemia, non-diabetic hypoglycemia
- MeSH terms
- Autoantibodies, Autoimmune Diseases, Female, Humans, Hypoglycemia, Insulin Antibodies, Middle Aged, Recurrence, Syndrome
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