A Case of Type 2 Diabetes Mellitus Presenting as Factitious Hypoglycemia by Insulin Analog Injection Using Differences in Two Types of IRI Measurement

DOI Web Site 13 References
  • Sugisawa Eri
    Diabetes Center, Tokyo Women's Medical University
  • Jinba Sachiyo
    Diabetes Center, Tokyo Women's Medical University Aoyama Hospitals, Tokyo Women's Medical University
  • Miura Junnnosuke
    Diabetes Center, Tokyo Women's Medical University
  • Maruyama Satoko
    Diabetes Center, Tokyo Women's Medical University
  • Ishii Akiko
    Diabetes Center, Tokyo Women's Medical University
  • Sato Asako
    Diabetes Center, Tokyo Women's Medical University Division of Clinical Laboratory, Clinical Laboratory Center, Tokyo Women's Medical University
  • Uchigata Yasuko
    Diabetes Center, Tokyo Women's Medical University
  • Iwamoto Yasuhiko
    Diabetes Center, Tokyo Women's Medical University

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Other Title
  • 2つのIRI測定法の違いによりインスリンアナログ製剤によるfactitious hypoglycemiaが疑われた糖尿病の1例
  • 症例報告 2つのIRI測定法の違いによりインスリンアナログ製剤によるfactitious hypoglycemiaが疑われた糖尿病の1例
  • ショウレイ ホウコク フタツ ノ IRI ソクテイホウ ノ チガイ ニ ヨリ インスリンアナログ セイザイ ニ ヨル factitious hypoglycemia ガ ウタガワレタ トウニョウビョウ ノ 1レイ

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A 43-year-old woman diagnosed with type 2 diabetes in 2002 and treated with an oral hypoglycemic agent (OHA) and insulin was admitted for improving continuous hypoglycemia control in May 2008. Despite large insulin doses-154 units/day-blood glucose exceeded 300 mg/dl. One day before a colonoscopy examination, blood glucose decreased to 51 mg/dl, and insulin and all OHA were discontinued. Despite intravenous administration of 50% glucose, hypoglycemia continued. After hospitalization, blood glucose decreased to 26-60 mg/dl at night. Plasma immunoreactive insulin (IRI) during hypoglycemia was extremely high-30 1300 μU/ml-with insulin antibody for both human insulin and insulin analog. Measured with another methed, however, IRI was not so high-0.2-30 μU/ml-and insulin antibody did not recognize insulin analog. Other factors possibly causing hypoglycemia were denied in a full investigation. Taking advantage of the difference in epitopes between two antibodies to insulin, it may be possible to approach factitious hypoglycemia using insulin analogue injection.

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