Brief report: hypoglycemia due to a monoclonal insulin-binding antibody in multiple myeloma

Article Abstract:

A 73-year-old man was diagnosed with multiple myeloma, or cancer of the bone marrow, with autoimmune insulin syndrome. Autoimmune insulin syndrome is a disorder in which the body produces antibodies that bind the hormone insulin. The patient, who had been hospitalized three days earlier for chronic obstructive lung disease, had a convulsion and became unconscious. The patient was hypoglycemic, and responded well to treatment with intravenous glucose. A biopsy of bone marrow tissue indicated that the patient had multiple myeloma. Analysis of the patient's blood revealed that he had autoimmune insulin syndrome, and that tumor cells were producing an antibody that could bind insulin. The patient was treated with diazoxide and glucocorticoids to prevent hypoglycemia, and was put on a low-carbohydrate, high-protein, high-fat diet with snacks between meals. The patient continued to have hypoglycemic episodes, but he did not have any more seizures. The patient underwent chemotherapy for the multiple myeloma, but he eventually died of respiratory failure.

Physiological aspects, Insulin resistance, Hypoglycemia, Multiple myeloma

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Pancreatic and islet transplantation for diabetes - cures or curiosities?

Article Abstract:

Transplantation of the pancreas or pancreatic islet cells may be an effective treatment for diabetes mellitus. Diabetes mellitus is a metabolic disorder caused by decreased secretion of insulin by pancreatic islet cells. Pancreatic transplantation was first performed as a treatment for diabetes in the 1960s, but patient survival was short during this era. Survival has improved with the use of immunosuppressive drugs, but most patients must also undergo a kidney transplant. Successful pancreatic transplantation may result in improved metabolic control of blood glucose (sugar) levels in diabetes patients. It may also slow down the progression of some of the chronic complications that affect diabetes patients. Pancreatic islet cell transplantation was first performed after isolation of islet cells in 1967. Some patients with insulin-dependent diabetes may no longer require insulin supplementation after undergoing this procedure. One problem with islet transplantation is that immunosuppressive therapy may impair the function of the transplanted cells.

Care and treatment, Surgery, Diabetes, Diabetes mellitus, Pancreas, Islands of Langerhans, Islets of Langerhans, Pancreas transplantation

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