Reduction in insulin requirements in second trimester in a woman with type 2 diabetes mellitus associated with anti-insulin antibodies: A case of exogenous insulin autoimmune syndrome?

Falling insulin requirements during pregnancy in women with diabetes mellitus in pregnancy raise concerns regarding placental insufficiency and adverse pregnancy outcome. A case of a rapid fall in insulin requirements in a woman with type 2 diabetes mellitus, obesity, hypertension and chronic kidney disease at 23 weeks’ gestation with high titres of insulin antibodies is presented. The possibility of exogenous insulin autoimmune syndrome as a cause for hypoglycaemia and reduction in insulin requirements is discussed.