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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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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Insulin: Dosing Regimen and Adverse Effects01:16

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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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Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
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Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
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Updated: Nov 1, 2025

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Malignant insulinoma hypoglycaemia: complex palliative management.

Lauri Simkiss1, Frances Hakkak2, Rajeev Raghavan3

  • 1Specialist Palliative Care Team, University Hospital of North Tees, Stockton-on-Tees, UK lauri.simkiss@doctors.org.uk.

BMJ Supportive & Palliative Care
|June 24, 2021
PubMed
Summary

This case study shows how flash glucose monitoring helped a patient with metastatic malignant insulinoma manage hypoglycemia. This technology reduced patient distress and anxiety, improving quality of life during palliative care.

Keywords:
pancreaticparaneoplastic disordersquality of lifesymptoms and symptom management

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Area of Science:

  • Endocrinology
  • Oncology
  • Palliative Care

Background:

  • Metastatic malignant insulinoma can cause severe hypoglycemia, significantly impacting patient quality of life.
  • Effective management of hypoglycemia is crucial for patients with advanced cancer.

Purpose of the Study:

  • To describe the medical management and supportive care for a patient with metastatic malignant insulinoma experiencing frequent hypoglycemic episodes.
  • To highlight the first documented use of flash glucose monitoring in a patient with insulinoma.

Main Methods:

  • A case presentation of a 65-year-old woman with metastatic malignant insulinoma.
  • Alteration of medical management and provision of supportive care.
  • Implementation and evaluation of flash glucose monitoring.

Main Results:

  • Flash glucose monitoring was successfully used in a patient with insulinoma.
  • The technology reduced the discomfort of lancet use and anxiety associated with hypoglycemia.
  • Improved quality of life for the patient.

Conclusions:

  • An individualized, multidisciplinary approach is beneficial for managing complex cases like metastatic malignant insulinoma.
  • Flash glucose monitoring may be a valuable tool in palliative care for patients with insulinoma.
  • Further research into flash glucose monitoring in palliative care settings is recommended.