ArticleMedicine2026
Exogenous insulin antibody syndrome presenting with concurrent hypoglycemia and hyperglycemia: A case report following complete pancreatectomy.
Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
rationaleAntibodies against therapeutic insulin cause paradoxical hypoglycemia, termed exogenous insulin antibody syndrome (EIAS). This first report of glargine-induced EIAS post-total pancreatectomy introduces mycophenolate mofetil (MMF) as a novel steroid-sparing therapy. PATIENT CONCERNS: A 75-year-old woman developed refractory nocturnal hypoglycemia with daytime hyperglycemia (HbA1c 8.6%) 3 months post-pancreatectomy during glargine therapy. DIAGNOSES: Hypoglycemia (glucose 2.83 mmol/L) featured undetectable C-peptide, elevated insulin (103 μU/mL), high insulin autoantibodies (74.95 coi, Reference range 0-1.0), and polyethylene glycol (PEG) precipitation-confirmed antibody-bound insulin, with a marked decline in insulin concentration relative to baseline values (88% decline).
interventionsStandard approaches (switching to aspart insulin, carbohydrate enrichment, degludec/acarbose triple regimen) failed; prednisone alleviated hypoglycemia but provoked hyperglycemia. OUTCOMES: Mycophenolate mofetil (MMF) eliminated hypoglycemia within 2 weeks, reducing antibodies to 35.4 coi.
conclusionThis inaugural case highlights EIAS as a cause of unexplained hypoglycemia in pancreatectomized patients. MMF warrants consideration as primary immunosuppressive therapy for EIAS. LESSONS: This case highlights that EIAS is a rare but important cause of paradoxical hypoglycemia and hyperglycemia in insulin-treated patients. MMF can serve as an effective therapeutic agent.
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