Glucose
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Glucose Hyperinsulinaemia leading to postprandial hypoglycaemia: case report
A 52-year-old woman developed hyperinsulinaemia leading to postprandial hypoglycaemia following administration of glucose. The woman presented to the hospital for evaluation of darkening of the eyes, cold sweating, poor concentration, weakness and dizziness within 3 hours of consumption of sugary foods. Her symptoms were persistent since one and a half year. She experienced the same symptoms frequently in the post-prandial period and the frequency and severity of her symptoms increased over a year. At presentation, physical examination revealed obesity. Further evaluation led to the diagnosis of reactive (post-prandial) syndrome. The physician suggested an diet and lifestyle improvement. Her first routine laboratory examinations were normal, and she had no symptoms that indicated non-specific prominent neuroglycopenia. Therefore, she was started on acarbose during her follow-up visits; however, no improvement was noted in her symptoms. Thereafter, 100g oral glucose tolerance test was performed in another hospital. After 5 hours of the test, she was hospitalised due to decreased blood glucose level to 30 mg/dL. Subsequent investigations did not show any other abnormalities, and a long fasting test was performed. The test was stopped at 19 hours, as she developed fatigue, fell asleep and her blood sugar level was 39 mg/dL. The glucose and insulin levels at 30, 60 and 90 minutes after feeding/IV dextrose [dosage and indication not stated] administration were 71, 79 and 75 mg/dL and 80, 99 and 153 mU/mL, respectively. The pre-prandial blood glucose, insulin and C-peptide levels were 44 mg/dL, 1.6 mU/mL and 1.16 ng/mL, respectively. The post-prandial levels of blood glucose, insulin and C-peptide were 40 mg/dL, 150 mU/mL and 15 ng/mL, respectively. Both the pre-prandial and post-prandial period showed hypoglycaemia, but her post-prandial insulin and C-peptide values were significantly higher. Hence, it was concluded that, the postprandial symptomatic hypoglycaemia was related to the hyperinsulinaemia. Thereafter, the premixed meal test was performed. After 2 hours of the test, her blood glucose level was 35 mg/dL and insulin level was 60 mU/mL. Based on the test results, she was diagnosed with post-prandial endogenous hyperinsulinaemia-related hypoglycaemia secondary to glucose administration [duration of treatments to reaction onsets not stated]. Thereafter, a multiphasic CT scan and ultrasonography revealed a 11 × 15 × 12mm size mass lesion, anteriorly in the head and uncinate process of the pancreas. As a corrective measure, she underwent pancreatic enucleation. Subsequent histopathologic examination revealed a neuroendocrine tumour (insulinoma). Mixed-meal test performed 6 months after surgery was completely normal. Koca N, et al. Insulinoma case admitted with reactive hypoglycemia symptoms. Current Diabetes Reviews 16: 790-796, No. 7, 2020. Available from: URL: http:// doi.org/10.2174/1573399815666190712200716
0114-9954/20/1825-0001
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