SEARCH RESULTS FOR: Secondary-hypoglycemia-Insulin-Mediated

Secondary hypoglycemia Insulin Mediated

Hypoglycemia: Insulin mediated secondary causes Insulinoma (pancreatic beta islet cell tumour) Non-insulinoma pancreatic islet cell disorder (e.g. Non-insulinoma pancreatogenous hypoglycemia syndrome) Nesidioblastosis (pancreatic islet tissues formed from pancreatic duct budding) formation ↑ In number & size of abnormal pancreatic beta islet cells throughout the entire pancreas ↑ Insulin production & secretion by abnormal pancreatic islet cells ↑ Glycogen synthesis Insulin autoimmune syndrome Autoantibodies bind to insulin molecules released post-meal Insulin molecules unable to exert effects Hyperglycemia Promotes insulin release ↓ Plasma glucose concentration ↓ Insulin release & ↓ total insulin levels Insulin molecules dissociate from autoantibodies ↑ Free insulin levels (inappropriate for the ↓ plasma glucose levels) ↓ Glycogenolysis (glycogen breakdown to glucose) Hypoglycemia (serum glucose of <3mmol/L) Intake of insulin secretagogues (e.g. Sulphonylureas, Meglitinide analogues) Binds to adenosine triphosphate (ATP) dependant potassium channels on pancreatic islet cells Inhibit potassium ion efflux through ATP-dependent potassium channels Pancreatic islet cell depolarization Opens voltage-gated calcium channel Calcium influx into pancreatic islet cells ↑ Insulin release ↓ Gluconeogenesis (glucose synthesis from non-carbohydrate compounds) Exogenous insulin intake Suppress endogenous insulin production (by beta cells) Low C-peptide levels (byproduct of endogenous pro- insulin being converted to insulin) 90% caused by somatic mutations of pancreatic beta islet cells 10% due to genetic changes linked to MEN1(Multipl e endocrine neoplasia type-1) gene mutation ↑ Pancreatic islet cells proliferation ↑ Insulin secretion by hyperplastic (increasing in number) pancreatic islet cells Neuroglycopenic symptoms (altered mental status, seizures) Neurogenic symptoms (palpitations, tremulousness, diaphoresis Authors: Iffat Naeem Run Xuan (Karen) Zeng Reviewers: Gurreet Bhandal Luiza Radu Yan Yu* Samuel Fineblit* * MD at time of publication Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Sept 29, 2024 on www.thecalgaryguide.com