Hyperinsulinemia: Description, Causes and Risk Factors:HyperinsulinemiaIncreased levels of insulin in the plasma due to increased secretion of insulin by the beta cells of the pancreatic islets; decreased hepatic removal of insulin is a cause in some patients, although hyperinsulinism usually is associated with insulin resistance and is commonly found in obesity in association with varying degrees of hyperglycemia.Insulin is produced by your pancreas and helps regulate blood sugar. Hyperinsulinemia is a sign of an underlying problem controlling blood sugar, which requires your pancreas to secrete large amounts of insulin to keep your blood sugar within a normal range.Hyperinsulinemia is caused by too many simple carbohydrates with too little protein. Low fat diets and diets high insaturated fats also contribute to the development of this problem. Low glycemic carbohyderates are complex carbohyderates that trigger less insulin production. So, consuming low glycemic carbohyderates in proper balance with high quality fats and proteins is the first step to overcoming hyperinsulinemia.Rarely, hyperinsulinemia is caused by:A tumor of the insulin-producing cells of the pancreas (insulinoma).
  • Excessive numbers of insulin-producing cells in the pancreas (nesidioblastosis).
Symptoms:There are often no visible symptoms of hyperinsulinemia unless hypoglycemia (low blood sugar) is present.Some patients may experience a variety of symptoms when hypoglycemia is present, including:Temporary muscle weakness.
  • Brain fog.
  • Fatigue.
  • Temporary thought disorder, or inability to concentrate.
  • Visual problems such as blurred vision or double vision.
  • Headaches.
  • Shaking/Trembling.
  • Thirst.
Diagnosis:All patients suspected of having hyperinsulinemia should have blood obtained for measurement of concentrations of glucose, insulin, growth hormone, cortisol, free fatty acids, and beta-hydroxybutyrate. ABG measurement and assessment of lactate, pyruvate, and alanine levels are also helpful. These studies should be performed while the patient is hypoglycemic. Because most patients in a metabolic crisis present to a general practitioner rather than to a pediatric endocrinologist, the undiagnosed patient is bemused when the practitioner obtains serum during the crisis. The practitioner should obtain 5-10 mL of whole blood in a plain red-top tube (without heparin) and instruct the laboratory to centrifuge the specimen to separate the serum for storage at -20°C within an hour of collection. This precious frozen serum from the time of the critical event can then be analyzed appropriately after consultation with the subspecialist.A plasma insulin level higher than 2 µU/mL and a serum glucose concentration less than 60 mg/dL is diagnostic of hyperinsulinemia. Infants with hyperinsulinemia require unusually high rates of glucose infusion (>12 mg/kg/min compared with the physiologic rate of 6-8 mg/kg/min) to maintain glucose levels higher than 60 mg/dL. A glucose-to-insulin ratio below 3 and low concentrations of free fatty acids and ketones during hypoglycemia are highly suggestive of hyperinsulinemia.Low levels of beta-hydroxybutyrate (< 1 µmol/L) in conjunction with low levels of free fatty acids (< 1 µmol/L) during hypoglycemia may indicate hyperinsulinemia.Finding low levels (< 120 ng/mL) of insulin-like growth factor binding protein-1 (IGFBP-1) may be useful. Insulin suppresses secretion of IGFBP-1, which normally is elevated in the fasting or hypoglycemic child, unless hyperinsulinemia is present and suppresses hepatic IGFBP-1 release.C-peptide levels should be elevated proportionately elevated with insulin levels. A low C-peptide level with a high insulin level may indicate surreptitious insulin administration.If ingestion of oral hypoglycemic medications is suspected, a drug screen may be beneficial.Treatment:Treatment is typically achieved via diet and exercise, although Metformin may be used to reduce insulin levels in some patients (typically where obesity is present).A referral to a dietician is beneficial.A healthy diet that is low in sugar and carbohydrate, and high in protein, is usually recommended. This includes replacing white bread with whole-grain bread, reducing intake of vegetables such as potato, and increasing intake of green vegetables. Chicken is also preferable to red meat and pork in reducing insulin levels.Regular monitoring of weight, blood sugar, and insulin are advised, as hyperinsulinemia may develop into diabetes.NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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