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A typical presentation of type B insulin resistance syndrome with isolated hypoglycaemia and suppressed insulin
  1. Natasha Brown1,
  2. Stephen Du Toit2,
  3. John Conaglen1 and
  4. Marianne Elston3,4
  1. 1Department of Endocrinology, Waikato District Health Board, Hamilton, New Zealand
  2. 2Department of Biochemistry, Waikato District Health Board, Hamilton, New Zealand
  3. 3Univ Auckland, Hamilton, New Zealand
  4. 4Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand
  1. Correspondence to Dr Natasha Brown; tashi{at}


Type B insulin resistance syndrome is a rare autoimmune disorder affecting glucose homeostasis characterised by the presence of serum autoantibodies to the insulin receptor. Typically, these patients present with severe insulin resistance although a mixed hyperglycaemic and hypoglycaemic phenotype may also occur, as can an exceptionally rare isolated hypoglycaemia presentation. The classic biochemical pattern comprises elevated insulin levels despite significant hypoglycaemia. We report an adult man presenting with isolated hypoglycaemia and suppressed serum insulin and C-peptide levels. He demonstrated evidence of autoimmunity with positive antinuclear antibodies, reactive lymphadenopathy and cytopaenias but did not meet the criteria for systemic lupus erythematosus and underlying malignancy was not identified despite extensive investigation. Insulin receptor antibodies were present. Treatment with prednisone led to resolution of hypoglycaemia, with no recurrence after 36 months of follow-up. However, 42 months after initial presentation, he represented with high-grade lymphoma.

  • metabolic disorders
  • diabetes
  • connective tissue disease
  • systemic lupus erythematosus
  • malignant and benign haematology

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  • Contributors NB: conception, data collection and interpretation, manuscript draft, critical review and approval of final manuscript. SDT: analysis laboratory investigations; critical review and final approval of manuscript. JC: final approval of manuscript. ME: conception, data interpretation, manuscript draft, critical review and approval of final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.