Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia caused by insulin autoantibodies in the absence of exogenous insulin administration. Some drugs containing sulfhydryl compounds are known to initiate the onset of IAS. A 67-year-old female who had diabetes for 5 years visited the outpatient clinic at our institution due to diabetic peripheral polyneuropathy. She was prescribed α-lipoic acid (ALA), which contains two sulfur atoms. Two weeks later, she complained of recurrent hypoglycemic symptoms. We detected a high level of insulin and high titers of insulin autoantibodies. Her human leukocyte antigen (HLA) genotype included the DRB1*0406 allele, which indicates a high level of susceptibility to IAS. She was treated with prednisolone. After this episode, she experienced two more hypoglycemic events after taking ALA for diabetic neuropathy in other hospitals. As ALA can be used to treat diabetic peripheral polyneuropathy, physician discretion is advised based on the possibility of IAS due to ALA in diabetic patients.

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• Long-term follow-up after discharge witnesses a slow decline of insulin autoantibodies in patients with insulin autoimmune syndrome complicated with Grave’s disease: a report of two cases
  Lili Zhao, Jinzhi He, Shandong Ye, Chao Chen, Jie Zhu, Chunchun Xiao, Tingni Wu, Zhicheng Liu
  BMC Endocrine Disorders.2023;[Epub]     CrossRef
• Postprandial hyperinsulinemic hypoglycemia
  A. A. Akmedova, F. O. Ushanova
  FOCUS. Endocrinology.2023; 4(3): 74.     CrossRef
• Effects of alpha lipoic acid on metabolic syndrome: A comprehensive review
  Nahid Najafi, Soghra Mehri, Mahboobeh Ghasemzadeh Rahbardar, Hossein Hosseinzadeh
  Phytotherapy Research.2022; 36(6): 2300.     CrossRef
• Alpha-Lipoic Acid and Glucose Metabolism: A Comprehensive Update on Biochemical and Therapeutic Features
  Umberto Capece, Simona Moffa, Ilaria Improta, Gianfranco Di Giuseppe, Enrico Celestino Nista, Chiara M. A. Cefalo, Francesca Cinti, Alfredo Pontecorvi, Antonio Gasbarrini, Andrea Giaccari, Teresa Mezza
  Nutrients.2022; 15(1): 18.     CrossRef
• Analysis of the clinical characteristics of insulin autoimmune syndrome induced by alpha‐lipoic acid
  Zuojun Li, Yanhong Su, Dan Yi, Cuifang Wu, Weijin Fang, Chunjiang Wang
  Journal of Clinical Pharmacy and Therapeutics.2021; 46(5): 1295.     CrossRef
• Scientific opinion on the relationship between intake of alpha‐lipoic acid (thioctic acid) and the risk of insulin autoimmune syndrome
  Dominique Turck, Jacqueline Castenmiller, Stefaan de Henauw, Karen Ildico Hirsch‐Ernst, John Kearney, Helle Katrine Knutsen, Inge Mangelsdorf, Harry J McArdle, Androniki Naska, Carmen Pelaez, Kristina Pentieva, Alfonso Siani, Frank Thies, Sophia Tsabouri,
  EFSA Journal.2021;[Epub]     CrossRef
• Management of Insulin Autoimmune Hypoglycaemia: Single‐centre experience from Western India with systematic review of world literature
  Muniraj Patel, Ravikumar Shah, Swati Ramteke‐Jadhav, Virendra Patil, Shivendra Kumar Patel, Anurag Lila, Nalini Shah, Tushar Bandgar
  Clinical Endocrinology.2020; 92(5): 409.     CrossRef
• Glucose Changes in a Patient With Insulin Autoimmune Syndrome Demonstrated by Continuous Glucose Monitoring
  Shi-Dou Lin, Shang-Ren Hsu
  AACE Clinical Case Reports.2019; 5(1): e35.     CrossRef
• Insulin Autoimmune Syndrome in a 25-Year-Old, Previously Healthy Kuwaiti Man
  Einas Alrashidi, Thamer Alessa
  Case Reports in Endocrinology.2019; 2019: 1.     CrossRef
• Insulin autoimmune syndrome in an Argentine woman taking α-lipoic acid: A case report and review of the literature
  Valentina Izzo, Carla Greco, Diana Corradini, Marco Infante, Maria Teresa Staltari, Maria Romano, Alfonso Bellia, Davide Lauro, Luigi Uccioli
  SAGE Open Medical Case Reports.2018; 6: 2050313X1881960.     CrossRef
• Assessment and Management of Anti-Insulin Autoantibodies in Varying Presentations of Insulin Autoimmune Syndrome
  David Church, Luís Cardoso, Richard G Kay, Claire L Williams, Bernard Freudenthal, Catriona Clarke, Julie Harris, Myuri Moorthy, Efthmia Karra, Fiona M Gribble, Frank Reimann, Keith Burling, Alistair J K Williams, Alia Munir, T Hugh Jones, Dagmar Führer,
  The Journal of Clinical Endocrinology & Metabolism.2018; 103(10): 3845.     CrossRef
• Current Status of Health Foods Including Their Interactions with Drugs and Adverse Events
  Yoshiro Saito
  YAKUGAKU ZASSHI.2018; 138(12): 1511.     CrossRef
• Autoimmune hypoglycaemia caused by alpha-lipoic acid: a rare condition in Caucasian patients
  A Veltroni, G Zambon, S Cingarlini, M V Davì
  Endocrinology, Diabetes & Metabolism Case Reports.2018;[Epub]     CrossRef
• GLP‑1R agonists ameliorate peripheral nerve dysfunction and inflammation via p38 MAPK/NF‑κB signaling pathways in streptozotocin‑induced diabetic rats
  Jingjing Ma, Min Shi, Xiangcheng Zhang, Xiaoning Liu, Juan Chen, Ridong Zhang, Xingzhou Wang, Hong Zhang
  International Journal of Molecular Medicine.2018;[Epub]     CrossRef
• Insulin autoimmune syndrome associated with alpha-lipoic acid in a young woman with no concomitant disease
  Sang Bae Lee, Min Young Lee, Ji Hong You, Seong Han Kim, Ji Sun Nam
  Yeungnam University Journal of Medicine.2017; 34(1): 115.     CrossRef
• The insulin autoimmune syndrome (IAS) as a cause of hypoglycaemia: an update on the pathophysiology, biochemical investigations and diagnosis
  Adel A.A. Ismail
  Clinical Chemistry and Laboratory Medicine (CCLM).2016; 54(11): 1715.     CrossRef
• Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
  Won-Young Lee
  Endocrinology and Metabolism.2014; 29(3): 251.     CrossRef