| Abstrakt: |
Efficacy of Teneligliptin in Indian Setting: The maintenance of blood glucose (BG) levels closely depends on coupling of insulin-insulin receptors and BG levels. Any disruption leads to BG imbalance. Auto-immune hypoglycaemia is one such cause for BG variation attributed to humoral auto-immunity, i.e. auto-antibodies against insulin or insulin-receptors. Since, it is independent of exogenous insulin administration; AIH is attributed to non-diabetics. Incidence of AIH in Japan is quite high, but in India its a prevalent condition requiring prompt diagnosis to avoid unnecessary investigation and management. Case Study: A 62-year-old male presented to emergency with c/o altered sensorium, having no history of diabetes, but was a known hypertensive. Examinations revealed BP was 150/90 mmHg and RBS was 40 mg/dl. Further to that, continuous blood-glucose monitoring with CGMS-Device was done for 24-48 hrs revealing persistent hypoglycaemia warranting further investigations via endoscopic USG, CT and MRI Scan to locate any insulin-secreting tumor and anti-insulin antibodies meanwhile. Results: With the presence of hypoglycaemia and BG levels as low as 25 mg/dL, serum insulin--11455 mU/L (3.00 - 25.00 mU/L) and C-peptide--18.98 ng/ ml (0.81 - 3.85 ng/mL), the motive was to identify the exact cause. He showed no evidence of tumor or immunity-altered disease, but anti-insulin antibodies were positive, confirming AIH requiring appropriate management. Conclusion: Elevated C-peptide, Serum Insulin levels and positive anti-insulin antibodies highlights the incidence of Auto-Immune Hypoglycamia. He was treated with Diazoxide 50 mg and Prednisolone 20 mg, later discontinuing Diazoxide and tapering the dose of Prednisolone. After 6 months, the patient was switched to Hydrocortisone 5 mg. On regular follow-up, he was stable indicating positive steroid response (PPBS-119 mg/ dL). Thus, suspecting AIH at the right time is essential to avoid any invasive surgical procedures. [ABSTRACT FROM AUTHOR] |
