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10.1530/EDM-16-0064 http://scihub22266oqcxt.onion/10.1530/EDM-16-0064 C5093380!5093380!27855237     free     free     free Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534       Endocrinol+Diabetes+Metab+Case+Rep 2016 ; 2016 (ä): ä Nephropedia Template TP {{tp|p=27855237|t=2016. Insulin Autoimmune Syndrome: a rare cause of postprandial hypoglycemia |pdf=|usr=}}{{27855237}} gab.com Text Insulin Autoimmune Syndrome: a rare cause of postprandial hypoglycemia JO: Endocrinol Diabetes Metab Case Rep http://www.kidney.de/pget.php?&tw=1&pmid=27855237 #FOAvip A 65-year-old obese Caucasian woman presented with symptomatic postprandial hypoglycemic episodes, resolution of symptoms with carbohydrate intake and significantly elevated anti-insulin antibody levels. She did not have any evidence for the use of oral antidiabetic medications, insulin, herbal substances, performing strenuous exercise or history of bariatric surgery. Fingerstick blood glucose readings revealed blood sugar of 35?mg/dL and 48?mg/dL, when she had these symptoms. Her medical history was significant for morbid obesity, hypothyroidism and gastro esophageal reflux disease. Her home medications included levothyroxine, propranolol and omeprazole. A blood sample obtained during the symptoms revealed the following: fingerstick blood sugar 38?mg/dL, venous blood glucose 60?mg/dL (normal (n): 70?99?mg/dL), serum insulin 202?IU/mL (n: <21), proinsulin 31.3?pmol/L (n: <28.9), C-peptide 8?ng/mL (n: 0.9?7), beta-hydroxybutyrate 0.12?mmol/L (n: 0.02?0.27) anti-insulin antibody >45.4?U/mL (n: <0.4). The result obtained while screening for serum sulfonylurea and meglitinides was negative. The repeated episodes of postprandial hypoglycemia associated with significantly elevated anti-insulin antibodies led to a diagnosis of insulin antibody syndrome (IAS). Significant improvement of hypoglycemic symptoms and lower anti-insulin antibody levels (33?U/mL) was noted on nutritional management during the following 6 months. Based on a report of pantoprazole-related IAS cases, her omeprazole was switched to a H2 receptor blocker. She reported only two episodes of hypoglycemia, and anti-insulin antibody levels were significantly lower at 10?U/mL after the following 12-month follow-up.Learning points:: Initial assessment of the Whipple criteria is critical to establish the clinical diagnosis of hypoglycemia accurately.Blood sugar monitoring with fingerstick blood glucose method can provide important information during hypoglycemia workup.Autoimmune hypoglycemia is a rare cause of hypoglycemia, which can be diagnosed on high index of clinical suspicion and systematic evaluation. Twit Text FOAVip Insulin Autoimmune Syndrome: a rare cause of postprandial hypoglycemia ????Endocrinol Diabetes Metab Case Rep http://www.kidney.de/pget.php?&tw=1&pmid=27855237 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=27855237 #FOAvip English Wikipedia <ref>{{Cite pmid|27855237}}</ref> Insulin Autoimmune Syndrome: a rare cause of postprandial hypoglycemia #MMPMID27855237 Sahni P; Trivedi N; Omer A Endocrinol Diabetes Metab Case Rep 2016[]; 2016 (ä): ä PMID27855237show ga A 65-year-old obese Caucasian woman presented with symptomatic postprandial hypoglycemic episodes, resolution of symptoms with carbohydrate intake and significantly elevated anti-insulin antibody levels. She did not have any evidence for the use of oral antidiabetic medications, insulin, herbal substances, performing strenuous exercise or history of bariatric surgery. Fingerstick blood glucose readings revealed blood sugar of 35?mg/dL and 48?mg/dL, when she had these symptoms. Her medical history was significant for morbid obesity, hypothyroidism and gastro esophageal reflux disease. Her home medications included levothyroxine, propranolol and omeprazole. A blood sample obtained during the symptoms revealed the following: fingerstick blood sugar 38?mg/dL, venous blood glucose 60?mg/dL (normal (n): 70?99?mg/dL), serum insulin 202?IU/mL (n: <21), proinsulin 31.3?pmol/L (n: <28.9), C-peptide 8?ng/mL (n: 0.9?7), beta-hydroxybutyrate 0.12?mmol/L (n: 0.02?0.27) anti-insulin antibody >45.4?U/mL (n: <0.4). The result obtained while screening for serum sulfonylurea and meglitinides was negative. The repeated episodes of postprandial hypoglycemia associated with significantly elevated anti-insulin antibodies led to a diagnosis of insulin antibody syndrome (IAS). Significant improvement of hypoglycemic symptoms and lower anti-insulin antibody levels (33?U/mL) was noted on nutritional management during the following 6 months. Based on a report of pantoprazole-related IAS cases, her omeprazole was switched to a H2 receptor blocker. She reported only two episodes of hypoglycemia, and anti-insulin antibody levels were significantly lower at 10?U/mL after the following 12-month follow-up.Learning points:: Initial assessment of the Whipple criteria is critical to establish the clinical diagnosis of hypoglycemia accurately.Blood sugar monitoring with fingerstick blood glucose method can provide important information during hypoglycemia workup.Autoimmune hypoglycemia is a rare cause of hypoglycemia, which can be diagnosed on high index of clinical suspicion and systematic evaluation. äInsulin Autoimmune Syndrome: a rare cause of postprandial hypoglycemia(epmc).pdf DeepDyve Pubget Overpricing