What is Autoimmune Hypoglycemia?

This is a rare condition where the body makes antibodies against insulin or the insulin receptor. These antibodies cause unpredictable swings in blood sugar, leading to severe hypoglycemia.

Two Types:

• Insulin Autoimmune Syndrome (Hirata Disease): Antibodies bind to insulin and release it randomly, causing sudden drops in blood sugar.
• Insulin Receptor Antibodies: Can cause either severe insulin resistance OR hypoglycemia (depending on whether the antibodies block or activate the receptor).

Who gets it?

• More common in people of Asian descent (especially Japanese).
• Often triggered by certain medications (like those containing sulfhydryl groups).

Symptoms:

• Severe, unpredictable episodes of hypoglycemia (shaking, sweating, confusion).
• Episodes often happen 3-4 hours after meals.

Diagnosis:

• High insulin levels during hypoglycemia (but the patient is NOT taking insulin).
• Positive insulin antibodies or insulin receptor antibodies.

Treatment:

• Stop offending medications.
• Dietary changes: Frequent small meals, low carbohydrate diet.
• Immunosuppression: Steroids or other immune-suppressing drugs in severe cases.
• Good News: Many cases resolve spontaneously within months.