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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
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Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
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Sulfonylureas are oral hypoglycemic agents utilized in treating type 2 diabetes. They are characterized by their unique sulfonylurea chemical structure. The family of sulfonylureas is divided into generations. First-generation sulfonylureas, including tolbutamide (Orinase), chlorpropamide (Diabinese), and tolazamide (Tolinase), trigger insulin release from pancreatic β cells and enhance peripheral tissues' insulin sensitivity. The second-generation members, such as glipizide...
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Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
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Unexplained Profound Hypoglycemia After Vocal Fold Lipoinjection.

Shohreh Modanlou1, Nicole Marie Giglio, Thomas Carroll

  • 1From the *Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts; and †Brigham and Women's Hospital, Boston, Massachusetts.

A & a Case Reports
|October 23, 2015
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Summary

Vocal fold injection using autologous fat is generally safe. However, one patient experienced a rare systemic side effect of hypoglycemia and hyperinsulinemia after the procedure.

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Area of Science:

  • Otolaryngology
  • Endocrinology
  • Surgical Complications

Background:

  • Vocal fold injection is a common procedure for treating glottal incompetence.
  • Autologous fat injection is a recognized method for vocal fold augmentation.
  • The procedure is typically well-tolerated with minimal complications.

Observation:

  • A 66-year-old male with vocal fold atrophy underwent bilateral vocal fold lipoinjection.
  • Post-procedure, the patient developed profuse sweating in the recovery area.
  • Blood glucose was critically low (24 mg/dL) with elevated insulin levels (246 mU/L).

Findings:

  • This case presents a rare systemic adverse event following vocal fold lipoinjection.
  • The patient experienced hypoglycemia and hyperinsulinemia, a previously unreported side effect.
  • The event occurred approximately 30 minutes after the surgical procedure.

Implications:

  • Highlights the potential for rare systemic complications even with well-tolerated procedures.
  • Suggests the need for closer monitoring of metabolic parameters post-vocal fold lipoinjection.
  • Underscores the importance of reporting unusual side effects to enhance procedural safety knowledge.