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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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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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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Asymptomatic Hyperinsulinaemic Hypoglycaemia.

Ana Isabel Ferreira1, Mariana Serino Barbosa2, Rita Coelho3

  • 1Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal.

European Journal of Case Reports in Internal Medicine
|October 21, 2020
PubMed
Summary
This summary is machine-generated.

Hypoglycaemia in non-diabetic patients requires investigation, especially with repeated low glucose levels. Endogenous hyperinsulinism diagnosis and treatment can be challenging, even without classic symptoms.

Keywords:
Endogenous hyperinsulinismhyperinsulinemic hypoglycemiahypoglycemia unawarenessinsulinoma

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Area of Science:

  • Endocrinology
  • Metabolic Disorders

Background:

  • Hypoglycaemia is uncommon in non-diabetic individuals.
  • Whipple's triad is a classic indicator for hypoglycaemia evaluation.
  • Endogenous hyperinsulinism can cause recurrent low blood glucose levels.

Purpose of the Study:

  • To present a case of endogenous hyperinsulinism.
  • To discuss diagnostic and therapeutic challenges.
  • To highlight the importance of investigating unexplained hypoglycaemia.

Main Methods:

  • Case report of endogenous hypoglycaemic hyperinsulinism.
  • Diagnostic evaluation for hyperinsulinism.
  • Treatment strategies for endogenous hyperinsulinism.

Main Results:

  • Documented recurrent low plasma glucose values.
  • Investigation confirmed endogenous hyperinsulinism.
  • Challenges encountered in identifying the aetiology.

Conclusions:

  • High suspicion is crucial for hospitalized patients with unexplained hypoglycaemia.
  • Repeated low glucose values (<40-55 mg/dl) warrant investigation, even without Whipple's triad.
  • Diagnosing and treating endogenous hyperinsulinism requires persistence, especially when the causative lesion is not evident.