How does hypoglycemia manifest?
Symptoms are divided into two groups. The first is associated with the release of stress hormones in response to a drop in sugar: trembling, palpitations, sweating, pallor, anxiety, acute hunger. The second occurs from a lack of glucose in the brain: impaired concentration, slurred speech, double vision, strange behavior, irritability, drowsiness, and in severe cases, convulsions and loss of consciousness. It is the second group that is often mistaken for a neurological or mental disorder, and the person goes through a long journey of examinations before their sugar is measured during an attack.
- Trembling, palpitations, sweating
- Feeling hungry and anxious
- Speech and concentration problems
- Strange behavior and irritability
- Convulsions and loss of consciousness during a severe attack
- Rapid improvement after eating
When does the doctor suspect insulinoma?
The classic benchmark is a combination of three conditions: symptoms of hypoglycemia, documented low blood sugar at that time, and resolution of symptoms after ingestion of carbohydrates. It is alarming that attacks occur on an empty stomach, at night, after exercise or when skipping a meal, and not after sweets. It is important to exclude much more common causes of low sugar: taking glucose-lowering medications, severe liver and kidney diseases, adrenal insufficiency, alcohol abuse. Separately, the doctor clarifies whether the family has access to insulin or pills.
- Attacks on an empty stomach and at night
- Improvement after eating
- Weight gain due to frequent snacking
- Absence of diabetes mellitus and hypoglycemic drugs
- Exclusion of diseases of the liver, kidneys, adrenal glands
- Taking into account the possibility of taking someone else's medications
Diagnostics
The main task is to prove that during low sugar, insulin remains high, which normally should not be the case. To do this, during an attack, blood is simultaneously taken for glucose, insulin, C-peptide and substances that prevent the use of pills. If attacks are rare, a fasting test is carried out in the hospital under the supervision of doctors - it is considered the most reliable. Only after confirmation of excess insulin do they begin to search for a tumor: ultrasound, computed tomography and MRI with contrast, and endoscopic ultrasound are used. Tumors are often small, so sometimes multiple methods are needed.
- Glucose, insulin and C-peptide during an attack
- Avoiding taking glucose-lowering medications
- Fasting test under observation in a hospital
- Ultrasound and computed tomography of the pancreas
- MRI with contrast
- Endoscopic ultrasound examination
- Screening for multiple endocrine neoplasia syndrome
What to do during an attack
If the person is conscious and can swallow, you need to give fast carbohydrates: a sweet drink, juice, dissolved sugar, and after a while add a product with slow carbohydrates so that the sugar does not drop again. If consciousness is impaired, nothing should be poured into the mouth due to the risk of getting into the respiratory tract: the person should be laid on his side and immediately call an ambulance by number 103. Before making a diagnosis, the doctor may recommend small meals with frequent meals and a mandatory snack before bed to reduce the risk of night attacks.
- Fast carbohydrates with preserved consciousness
- Then a product with slow carbohydrates
- If consciousness is impaired - position on one side and call 103
- Do not give anything by mouth to an unconscious person.
- Small meals and snacks before bed before surgery
- Keeping a seizure diary
Treatment
The main method is surgical removal of the tumor. In case of small single formations, enucleation is possible while preserving the gland; in case of a more complex location, part of the pancreas is removed. After a successful operation, the attacks stop and the person is considered recovered, although observation remains. If the tumor is not found, cannot be removed, or it is a malignant form with spread, drug therapy is prescribed that reduces the production of insulin and retains sugar. The regimen and scope of treatment are determined jointly by the endocrinologist, surgeon and oncologist.
- Enucleation of the tumor at a convenient location
- Resection of part of the pancreas
- Drug therapy for inoperable forms
- Observation after surgery
- Examination of relatives with hereditary syndrome
- Monitoring sugar levels in the early postoperative period
