The young woman had bouts of spontaneous vomiting. During them, she could “cough up” up to 6 liters
A 27-year-old woman has type 1 diabetes.This is an autoimmune disease in which the immune system attacks the cells of the pancreas that produce the hormone insulin. It helps move sugar out of the bloodstream and into cells, but the disease reduces the body's supply of this hormone, causing blood sugar, or glucose, levels to rise.
According to the 2020 report published byin the journal Diabetes Care, about one in five people with type I diabetes have some additional autoimmune disease. In the patient's case, such an autoimmune disease appears to be causing her to vomit, although her doctors are still figuring out which one it is.
Doctors first examined the patient in 2016.when she began having bouts of vomiting with a frequency of about once a month. She was then diagnosed with cyclic vomiting syndrome (CVS). After hospitalization, the patient's symptoms typically subsided within a few days, but then her blood sugar levels plummeted and remained low despite her insulin treatment being strictly controlled.
Later, scientists conducted a full-body examination, butit showed nothing. However, the patient's blood test revealed "extremely high" levels of autoantibodies to GAD, immune molecules that inadvertently attack the body's own tissues. They are found in patients with type I diabetes.
The patient’s blood also contained antibodieswhich “fix” on insulin. Scientists also observed an unusual phenomenon of insulin recycling, where the hormone returned to the bloodstream rather than being effectively destroyed by cells. Why this happens is unknown. However, the antibodies explained why the patient's blood sugar levels dropped even when she took insulin. Doctors tried to “wear out” them with various medications. It turned out that rituximab, which tags immune cells that produce antibodies, reduces the number of antibodies and corrects low blood sugar.
“In our opinion, cyclic vomiting syndrome"is unlikely to be associated with diabetes or insulin use," the scientists explain. This is because the syndrome is no more common in people with diabetes than in the general population. Therefore, scientists believe that SCR may be a separate autoimmune disease.
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