Modified cornstarch as an effective treatment for insulinoma-induced hypoglycemia: a case report

A 90-year-old male was admitted to the hospital due to recurrent symptomatic hypoglycemia. After ruling out the most common outpatient causes of hypoglycemia, endogenous hyperinsulinism was confirmed. An abdominal computed tomography (CT) scan revealed a 15 mm solid nodular lesion in the pancreatic tail. The (68)Ga-DOTA-TOC PET-CT findings led to the diagnosis of insulinoma. A multidisciplinary committee considered the patient unfit for surgery. The treatment was started with a low dose of diazoxide; however, side effects appeared as the dose was gradually increased. Consequently, a dietary approach was prioritized, incorporating modified cornstarch (Glycosade®) in fractionated doses administered under the guidance of continuous glucose monitoring. This strategy allowed for a reduction in the diazoxide dosage and effectively prevented further hypoglycemic episodes without additional side effects. Since the initial medical treatment was successful, the patient and his family preferred to avoid other possible minimally invasive treatments unless pharmacological and dietary approaches failed.