Hyperinsulinism (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview
Hyperinsulinism refers to abnormally high levels of insulin in association with documented hypoglycemia. The common cause of hyperinsulinism is insulinoma, which is a tumor of the islet cells secreting high amounts of insulin to decrease blood sugar concentrations. Other causes are misdiagnosed and inappropriate treatment for diabetes. Usual signs and symptoms include hunger, sweating, weakness, palpitations, confusion, stupor, even seizures, or coma and death. Blood tests of insulin and glucose, radioimmunoassay measures of insulin and its precursor, and abdominal imaging studies may identify the prognosis. Treatment depends on the cause of hyperinsulinism. Most individuals with hyperinsulinism who have a non-cancerous pancreatic insulinoma may get better outcomes than those with cancerous insulinoma.

What are the symptoms of hyperinsulinism?
Insulin may decrease your blood sugar. Patients with hyperinsulinism may show symptoms as following:


 * Hunger
 * Sweating
 * Weakness
 * Palpitations
 * Diplopia, blurred vision
 * Headache, dizziness
 * Emotional instability, anxiety
 * Confusion, stupor, even seizures, or coma and death.

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

Who is at highest risk?

 * Pancreatic insulinoma: An insulinoma is a tumor in the pancreas which is an organ in the abdomen that can make insulin to regulate blood sugar level. Patients with insulinoma can produce too much insulin and may show a series of symptoms of hypoglycemia.
 * Side effect of inappropriate treatment for diabetes: When receiving overdose of insulin or diabetes medicine, or not eating enough food with ordinary dosage, or suddenly increasing your exercise without increasing the amount of food you eat, patients with diabetes may appear symptoms of hypoglycemia.
 * Patients are misdiagnosed with diabetes and given insulin when it is not needed.
 * Obesity and consumption of a diet rich in carbohydrates are risk factors for this disease.

Diagnosis

 * Blood tests of insulin and glucose: Hyperinsulinism is characterized by high blood levels of insulin and low levels of blood sugar even after a period of time without food (fast). Further more, an overnight fasting test a 72-hour in-hospital fasting study with serial measurements of insulin and glucose levels can be done to prove the diagnosis.
 * Radioimmunoassay measures of insulin and its precursor: This method can be used for measuring the fasting insulin concentration and insulin precursor in the blood.
 * Levels of proinsulin, C-peptide, and urinary sulfonylureas: The goal of this measure is to rule out self-administration of insulin or hypoglycemic drugs.
 * Computed tomography (CT) and magnetic resonance imaging (MRI) scan: These imaging studies can be used to identify insulinoma. They can confirm the location of the tumor and show the organs near the pancreas.

When to seek urgent medical care?
Call your health care provider if symptoms of hyperinsulinism develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:


 * Confusion
 * Stupor
 * Seizures
 * Coma

Treatment options
Treatment depends on the cause of hyperinsulinism.
 * Keep a good lifestyle.
 * For patients with pancreatic insulinoma, surgical removal of the insulinoma and removing part of the pancreas, or medications such as diazoxide and somatostatin may be helpful.
 * If hyperinsulinism is caused by side effect of inappropriate treatment for diabetes, you need to keep similar food consumption and similar exercises and record your glucose, and take insulin or diabetes medicine under the doctor's direction.

Diseases with similar symptoms
When patients appear confuaion or coma, they need to differ from:
 * Diabetic ketoacidosis
 * Hyperosmolar nonketotic coma

Where to find medical care for hyperinsulinism?
Directions to Hospitals Treating hyperinsulinism

Prevention of hyperinsulinism
In diabetic patients, proper insulin management is be required to prevent a future overdose of insulin. Keeping similar food comsumption and similar exercises with ordinary dosage of insulin or diabetes medications.

What to expect (Outook/Prognosis)?
Prognosis of hyperinsulin depends on the cause of the disease. Outcomes from benign insulinoma may be better than cancerous insulinoma. But sometimes hopoglycemia may be fatal.