Autoimmune hypoglycemia due to alpha-lipoic acid: Report of two cases

Insulin autoimmune syndrome (IAS) is a rare cause of spontaneous hypoglycemia characterized by the presence of insulin autoantibodies. Alpha-lipoic acid (ALA), a widely used nutraceutical, has been increasingly recognized as a potential trigger for IAS. We report two cases of ALA-induced IAS in Indian patients and review existing literature to highlight its clinical presentation, diagnostic challenges, and management strategies. In the first case, rapid-onset severe hypoglycemia mandated the use of oral steroids with gradual tapering and stoppage over a duration of few months, while in the second case, mild hypoglycemia was essentially managed with dietary modifications alone and the condition remitted on its own. ALA-induced IAS should be considered in the differential diagnosis of hyperinsulinemic hypoglycemia. Early recognition and appropriate management can prevent severe complications and avoid unnecessary investigations to evaluate other causes of hyperinsulinemia.