Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Case Report
  • Published:

Hydrothermally modified slow release corn starch: a potential new therapeutic option for treating hypoglycemia in autoimmune hypoglycemia (Hirata’s disease)

Subjects

Abstract

We report the successful treatment of autoimmune hypoglycemia in an 82-year-old non-diabetic Caucasian male with hydrothermally modified slow release corn starch, a product which is used in other conditions associated with hypoglycemia, most typically glycogen storage disease type I. An 82-year-old-Caucasian male presented with recurrent spontaneous hypoglycemia as low as 30 mg/dl following in-patient treatment for community acquired pneumonia. During a fasting-test, symptomatic hypoglycemia occurred. Plasma concentrations of c-peptide and insulin were considerably elevated. Autoimmune hypoglycemia was confirmed by the presence of insulin autoantibodies. While dietary restriction alone did not result in sufficient glucose control in this patient with autoimmune hypoglycemia, treatment with hydrothermally modified slow release corn starch led to stable euglycemia. This easy, well tolerated and non-invasive treatment may constitute a new therapeutic option for hypoglycemia in patients with autoimmune hypoglycemia who do not achieve sufficient control of hypoglycemia by dietary restriction alone.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Wong SL, Priestman A, Holmes DT . Recurrent hypoglycemia from insulin autoimmune syndrome. J Gen Intern Med 2014; 29: 250–254.

    Article  Google Scholar 

  2. Bhattacharya K, Orton RC, Qi X, Mundy H, Morley DW, Champion MP et al. A novel starch for the treatment of glycogen storage diseases. J Inherit Metab Dis 2007; 30: 350–357.

    Article  CAS  Google Scholar 

  3. Correia CE, Bhattacharya K, Lee PJ, Shuster JJ, Theriaque DW, Shankar MN et al. Use of modified cornstarch therapy to extend fasting in glycogen storage disease types Ia and Ib. Am J Clin Nutr 2008; 88: 1272–1276.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Qi X, Band M, Tester R, Piggott J, Hurel SJ . Use of slow release starch (SRS) to treat hypoglycaemia in type 1 diabetics. J Nutr Food Sci 2010; 40: 228–234.

    Article  Google Scholar 

  5. Roberts MD, Lockwood C, Dalbo VJ, Volek J, Kerksick CM . Ingestion of a high-molecular-weight hydrothermally modified waxy maize starch alters metabolic responses to prolonged exercise in trained cyclists. Nutrition 2011; 27: 659–665.

    Article  CAS  Google Scholar 

  6. Alves C, Constanca J, De Leon DD, Snider K, Stanley C . A novel atypical presentation of insulin autoimmune syndrome (Hirata's disease) in a child. J Pediatr Endocrinol Metab 2013; 26: 1163–1166.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Kondrashova A, Viskari H, Kulmala P, Romanov A, Ilonen J, Hyoty H et al. Signs of beta-cell autoimmunity in nondiabetic schoolchildren: a comparison between Russian Karelia with a low incidence of type 1 diabetes and Finland with a high incidence rate. Diabetes care 2007; 30: 95–100.

    Article  CAS  Google Scholar 

  8. Jabri AL, Bayard C . Nesidioblastosis associated with hyperinsulinemic hypoglycemia in adults: review of the literature. Eur J Intern Med 2004; 15: 407–410.

    Article  CAS  Google Scholar 

  9. Vogeser M, Parhofer KG, Furst H, Jacob K, Brodl UC, Seidel D . Autoimmune hypoglycemia presenting as seizure one week after surgery. Clin Chem 2001; 47: 795–796.

    CAS  PubMed  Google Scholar 

  10. Nalin T, Venema K, Weinstein DA, de Souza CF, Perry ID, van Wandelen MT et al. In vitro digestion of starches in a dynamic gastrointestinal model: an innovative study to optimize dietary management of patients with hepatic glycogen storage diseases. J Inherit Metab Dis 2015; 38: 529–536.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to K G Parhofer.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lechner, K., Aulinger, B., Brand, S. et al. Hydrothermally modified slow release corn starch: a potential new therapeutic option for treating hypoglycemia in autoimmune hypoglycemia (Hirata’s disease). Eur J Clin Nutr 69, 1369–1370 (2015). https://doi.org/10.1038/ejcn.2015.151

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2015.151

Search

Quick links