Abstract
A 77-year-old male with hypertension was admitted to the hospital because of hypoglycemia. He had a history of back pain, and Loxoprofen had been prescribed for 1 month. The level of immunoreactive insulin was 196.6 μU/ml, anti-insulin antibody was positive, and HLA typing indicated the presence of the DRB1*04: 06 allele. The patient had not taken any medications, except for Loxoprofen, amlodipine, candesartan and hydrochlorothiazide. Therefore, he was diagnosed to have insulin autoimmune syndrome (IAS). He was initially permitted to take small meals 5 times a day to avoid hypoglycemia; however, hypoglycemia was observed several times. Subsequently, the patient was treated with an α-glucosidase inhibitor to decrease the frequency of hypoglycemia. Continuous glucose monitoring (CGM) showed that the α-glucosidase inhibitor could prevent hypoglycemia due to IAS. In conclusion, an α-glucosidase inhibitor should be considered for the treatment of hypoglycemia due to IAS. Further, CGM is useful for monitoring hypoglycemia.
