Plasmapheresis-remediable Hyperinsulinemic Hypoglycemia in a Patient with Diabetes, Hypertriglyceridemia, and Cardiomyopathy

We here report a case of plasmapheresis-remediable hyperinsulinemic hypoglycemia without evidence of severe insulin resistance or insulin antibodies. The clinical course and a concise review on hyperinsulinemic hypoglycemia are presented. A 44-year-old man with history of type 2 diabetes, hypertriglyceridemia, and severe dilated cardiomyopathy presented with fasting and postprandial hypoglycemia. Laboratory tests revealed extremely elevated insulin levels (>1000 μIU/mL), nonsuppressed C-peptide, and negative insulin antibodies. Computer tomography (CT) of abdomen and pelvis did not identify any mass in the pancreas. Patient failed conservative medical therapies. As plasmapheresis can remove free and protein-bound insulin, we experimented with plasmapheresis to control the hypoglycemia. After three sessions of plasmapheresis, insulin levels decreased and the patient did not have any hypoglycemic episodes afterwards. We conclude that plasmapheresis can be used to control idiopathic hyperinsulinemic hypoglycemia in patients who failed conservative medical treatments, even if their hyperinsulinemia is not caused by apparent autoimmunity.