Download PDF
Open Access
CC BY 4.0 · Journal of Diabetes and Endocrine Practice
DOI: 10.1055/s-0045-1812873
Case Report

Alpha-Lipoic Acid (ALA)-Related Insulin Autoimmune Syndrome

Authors

  • Hala Shahrour

    1   Department of Internal Medicine, Tawam & STMC Hospitals, Pure Health, Al Ain, United Arab Emirates

  • Mohamed Alqedra

    1   Department of Internal Medicine, Tawam & STMC Hospitals, Pure Health, Al Ain, United Arab Emirates

  • Raya Almazrouei 

    2   Division of Endocrinology, Department of Internal Medicine, Tawam & STMC Hospitals, Pure Health, Al Ain, United Arab Emirates
    3   Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain. United Arab Emirates

Funding and Sponsorship This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Further Information
Also available at
  Permissions and Reprints

Abstract

Insulin autoimmune syndrome (IAS) is a rare cause of hypoglycemia characterized by autoantibodies against endogenous insulin, often triggered by sulfhydryl-containing compounds such as alpha-lipoic acid (ALA). We report the case of a 43-year-old previously healthy woman who presented with recurrent fasting and postprandial hypoglycemia. Biochemical evaluation revealed inappropriately elevated insulin and C-peptide levels with negative sulfonylurea screen and no pancreatic lesion on imaging. Further history uncovered recent use of ALA, and markedly elevated insulin autoantibodies confirmed the diagnosis of ALA-induced IAS. Discontinuation of the supplement and dietary modification led to complete resolution of symptoms. This case highlights the importance of considering IAS in the differential diagnosis of unexplained hypoglycemia and underscores the need for detailed medication and supplement history.

Keywords

insulin autoimmune syndrome - hypoglycemia - alpha-lipoic acid - insulin autoantibodies - drug-induced autoimmunity

Patient Consent Statement

Informed consent was obtained from the patient for publication of this case report.


Authors' Contributions

All authors were involved in data collection, manuscript drafting, and finalizing. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.


Compliance with Ethical Principles

No ethical approval is required for single case report.


Availability of Data and Material

For confidentiality reasons, the original data cannot be shared. However, all results are presented in this manuscript.




Publication History

Article published online:
31 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India