胰岛素抗体诱导的高胰岛素血症性低血糖症的碱剂治疗新方法：一例报告
A novel treatment of hyperinsulinemic hypoglycemia induced by insulin antibodies with alkali administration: a case report.
作者信息
Kobayashi Seiji, Amano Houichi, Kawaguchi Yoshindo, Yokoo Takashi
机构信息
Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
出版信息
J Med Case Rep. 2019 Mar 11;13(1):79. doi: 10.1186/s13256-019-1989-8.
BACKGROUND
Insulin autoimmune syndrome is a rare cause of hyperinsulinemic hypoglycemia characterized by autoantibodies to human insulin without previous insulin use. We report a case of a patient with hyperinsulinemic hypoglycemia possibly caused by insulin antibodies induced by insulin analogs and a novel therapeutic measure for this condition.
CASE PRESENTATION
An 84-year-old Japanese man with a 28-year history of type 2 diabetes and chronic kidney disease, treated with biphasic insulin aspart 30, experienced persistent early morning hypoglycemia with daytime hyperglycemia. Despite discontinuation of biphasic insulin aspart 30, the condition persisted even after the patient ate small, frequent meals. Sodium bicarbonate was administered to correct the chronic metabolic acidosis, which then rectified the early morning glucose level.
CONCLUSIONS
We believe this to be the first published case of a therapeutic approach to the treatment of hyperinsulinemic hypoglycemia associated with insulin antibodies that factors in blood pH and the correction of acidosis using sodium bicarbonate, which physicians could consider.
背景
胰岛素自身免疫综合征是高胰岛素血症性低血糖的罕见病因，其特征为在既往未使用胰岛素的情况下出现人胰岛素自身抗体。我们报告一例高胰岛素血症性低血糖患者，可能由胰岛素类似物诱导的胰岛素抗体所致，并介绍针对该病症的一种新治疗措施。
病例介绍
一名84岁日本男性，有28年2型糖尿病和慢性肾脏病病史，接受门冬胰岛素30治疗，出现持续性清晨低血糖伴日间高血糖。尽管停用了门冬胰岛素30，但即使患者少食多餐，该情况仍持续存在。给予碳酸氢钠纠正慢性代谢性酸中毒，随后清晨血糖水平恢复正常。
结论
我们认为这是首例发表的关于治疗与胰岛素抗体相关的高胰岛素血症性低血糖的治疗方法，该方法考虑了血液pH值并使用碳酸氢钠纠正酸中毒，可供医生参考。
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