Two different mechanisms
In the first case, insulin is released autonomously, regardless of glucose levels. This is how insulinoma behaves - usually a small benign tumor of beta cells, as well as congenital hyperinsulinism in children and rare autoimmune forms. At the same time, sugar drops, and the main danger is hypoglycemia. In the second case, the tissues respond poorly to insulin, and the pancreas releases more of it compensatory. This is insulin resistance, characteristic of excess weight, inactivity and polycystic ovary syndrome. Here the sugar level is normal for a long time, but the problem is in the future of diabetes.
- Insulinoma - autonomous secretion of insulin
- Congenital hyperinsulinism in newborns
- Compensatory hyperinsulinemia with insulin resistance
- Dumping syndrome after gastric surgery
- Overdose of glucose-lowering drugs
- Rare autoimmune forms
Symptoms of hypoglycemia
Symptoms are divided into two groups. The first are associated with the release of adrenaline in response to a drop in sugar: trembling, sweating, palpitations, anxiety, sudden hunger, pallor. The latter reflect a lack of glucose in the brain: weakness, headache, impaired concentration, slurred speech, strange behavior, double vision, and in case of a severe fall - convulsions and loss of consciousness. The key feature of insulinoma is that attacks occur on an empty stomach, after a long break in food or after exercise and completely disappear after eating sweets.
- Trembling, cold sweat, palpitations
- Extreme hunger and anxiety
- Dizziness and weakness
- Speech and behavior disorders
- Darkening of the eyes, double vision
- Convulsions and loss of consciousness with severe hypoglycemia
Survey
Key principle: Elevated insulin in itself is not a diagnosis. It is important to fix low glucose levels simultaneously with inappropriately high insulin and C-peptide. Therefore, blood is taken precisely at the moment of an attack or during a special fasting test, which is carried out under the supervision of a doctor in a hospital. Additionally, glycated hemoglobin is assessed, and it is checked whether the person is taking glucose-lowering medications. If autonomous secretion is confirmed, a tumor is looked for using ultrasound, CT or MRI of the pancreas and special imaging methods.
- Blood glucose at the time of attack
- Insulin and C-peptide simultaneously with glucose
- Glycated hemoglobin
- Supervised fasting test
- Avoiding taking glucose-lowering medications
- Ultrasound, CT or MRI of the pancreas
Treatment
The tactic depends entirely on the reason. For insulinoma, the main method is surgical removal of the tumor, after which the attacks stop; Before surgery, attacks are prevented with fractional meals and medications that suppress insulin secretion. For insulin resistance, treatment begins not with pills, but with nutrition and movement: losing weight even by a few kilograms significantly improves tissue sensitivity to insulin. The doctor may add medications that affect glucose metabolism. Changing your diet helps with dumping syndrome. You cannot take glucose-lowering medications on your own.
- Surgical removal of insulinoma
- Small meals to prevent attacks
- Weight loss and regular physical activity
- Limiting fast carbohydrates and sugary drinks
- Drug therapy as prescribed by an endocrinologist
- Treatment of associated conditions, including polycystic ovary syndrome
What to do during an attack
If the person is conscious and can swallow, you need to give fast carbohydrates: sweet juice, sugar, honey, glucose tablets. Improvement usually occurs within 10-15 minutes, after which it is important to eat something longer digestible, such as bread or porridge, so that the sugar does not drop again. If a person is unconscious, do not pour anything into the mouth due to the risk of getting into the respiratory tract - you need to lay him on his side and immediately call an ambulance by number 103. Each episode of loss of consciousness requires mandatory medical attention.
- Fast carbohydrates with preserved consciousness
- Remeasure your sugar after 15 minutes
- Products with slow carbohydrates after stopping an attack
- Position on your side and call 103 if you lose consciousness
- Do not give anything by mouth to an unconscious person.
- Carry sweets and a status note with you