eMedicine Specialties > Pediatrics: General Medicine > Endocrinology
Hyperinsulinemia: Follow-up
Updated: Jul 9, 2008
Follow-up
Further Inpatient Care
- Admit patients for stabilization of blood glucose, further testing, and medical or surgical care.
- Blood glucose level should be determined before each oral feeding and when any symptom or sign of hypoglycemia is present. The most accurate blood glucose assessment is made by free blood drawn into a NaF-containing tube (gray top), with immediate processing to avoid spuriously low measurements resulting from glycolysis. A bedside glucometer can provide faster results, which need to be confirmed in the central laboratory only when the bedside value is below 60 mg/dL.
- All portable glucometers are inaccurate by as much as 20% when the measured blood glucose level is below 70 mg/dL. To reduce the possibility of neurologic injury, the blood glucose level should be maintained above 60 mg/dL at all times.
- Before discharging the patient from the hospital, perform a short fasting study (6-8 h) to ensure that the infant can safely tolerate a missed or inadequate feeding at home. The infant must be able to maintain a blood glucose level above 60 mg/dL throughout the fast.
- Ensure the training of caretakers and adequate home healthcare support for pump infusions (octreotide or glucagon) before discharging the patient from the hospital.
Further Outpatient Care
- Monitor medication dosages and side effects carefully, with frequent glucose level determinations.
- Monitor for symptoms and signs of hypoglycemia.
- Train caretakers to monitor blood glucose levels and to administer all medications at home.
Inpatient & Outpatient Medications
- Medications include diazoxide, octreotide, nifedipine, glucagon, growth hormone, and glucocorticoids. The choice of medications varies with etiology and severity of hypoglycemia.
Transfer
- Transfer of patient to a tertiary care facility is required to provide prompt diagnosis and medical treatment or surgical intervention.
- Referral to one of the aforementioned centers (see above) is preferred.
Deterrence/Prevention
- Avoid prolonged fasting. Seek medical attention if emesis or anorexia develops.
- Have source of glucose and glucagon emergency kit readily available if hypoglycemic symptoms appear.
Complications
- Seizures
- Permanent brain damage
- Death
Prognosis
- Multiple factors affect prognosis, such as the severity of the disease at presentation, duration of hypoglycemia, etiology of hyperinsulinism, and presence of neurologic complications.
- Improving diagnostic techniques make earlier and more appropriate surgical intervention (partial pancreatectomy or near-total pancreatectomy) possible.
- Patients who have had near-total pancreatectomy are at risk for developing exocrine pancreatic insufficiency and diabetes mellitus. Diabetes mellitus, which develops in patients with diffuse disease, is caused by dysregulation of insulin secretion in the residual beta cells after pancreatectomy.
Patient Education
- Counsel the patient, family members, and school personnel how to recognize the symptoms of hypoglycemia and how to administer glucose in the event of a hypoglycemic episode.
- Families should be equipped with glucagon and instructed in its use in case hypoglycemia does occur.
Miscellaneous
Medicolegal Pitfalls
- Failure to recognize and treat hypoglycemia
- Failure to recognize the cause of hypoglycemia
- Failure to counsel family how to recognize signs and symptoms of hypoglycemia and how or when to administer glucose or glucagon
- Failure to recognize associated conditions, such as cardiomyopathy in infants of diabetic mothers and associated problems with asphyxia
Special Concerns
- Some children with a known history of hypoglycemia may not be symptomatic. A high index of suspicion is essential for early detection and therapy.
More on Hyperinsulinemia |
| Overview: Hyperinsulinemia |
| Differential Diagnoses & Workup: Hyperinsulinemia |
| Treatment & Medication: Hyperinsulinemia |
 Follow-up: Hyperinsulinemia |
| Multimedia: Hyperinsulinemia |
| References |
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References
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Further Reading
Keywords
hyperinsulinemia, beta-cell hyperplasia, hyperinsulinemic hypoglycemia, nesidioblastosis, neonatal hyperglycemia, primary hyperinsulinemia, hypoglycemia in children, hypoglycemia in infants, hyperinsulinism, growth hormone deficiency, hypocortisolemia, maternal diabetes, birth asphyxia, macrosomia, Beckwith-Wiedemann syndrome, omphalocele, macroglossia, visceromegaly, drug-induced hyperinsulinism, maternal toxemia, erythroblastosis fetalis, Munchausen syndrome by proxy, nesidioblastosis, islet adenomatosis, beta-cell adenoma, persistent hyperinsulinemic hypoglycemia of infancy, PHHI, leucine-sensitive hypoglycemia, islet cell dysmaturation syndrome
