Insulinoma Testing

Connect the dots, la-la-la-la.

I saw an endocrinologist today, and apparently I went to the same doctor before back in 2007 with complaints of hypoglycemia, but I guess I just don't recall whatever came of it?  He -- unlike the Bariatric Surgeon -- seemed to recall who I was.  Go figure.  

It's now 2010, and finally... I will get testing to rule out or finally diagnose what I thought I might be dealing with, insulinoma due to nesidioblastosis caused by gastric bypass surgery.  

"With the increasing popularity of gastric bypass surgery for morbid obesity, physicians caring for these patients need to be aware of associated hypoglycemic syndromes. Indeed, hyperinsulinemic hypoglycemia has been described in these patients, primarily due to nesidioblastosis (2)."

I will be going inpatient for a 72 hour fast - 

"The standard test remains a 72-hour fast while the patient is closely observed (1); (3). More than 95% of cases can be diagnosed based on responses to a 72-hour fast. Serial glucose and insulin levels are obtained over the 72 hours until the patient becomes symptomatic. Because the absolute insulin level is not elevated in all patients with insulinomas, a normal level does not rule out the disease; however, a fasting insulin level of greater than 24 mU/mL is found in approximately 50% of patients with insulinoma. . Values of insulin greater than 7 mU/mL after a more prolonged fast in the presence of a blood glucose less than 40 mg/dL also are highly suggestive."

Okay.  I understood the process when the doctor described it -- however -- it does seems backwards, considering I typically drop drastically after eating, but since I do drop out of the sky sometimes and in the middle of the night?  

 

• About 85% of patients present with symptoms of hypoglycemia that include diplopia, blurred vision, palpitations, or weakness.
• Other symptoms include confusion, abnormal behavior, unconsciousness, or amnesia.
• About 12% of patients have grand mal seizures.
• Adrenergic symptoms (hypoglycemia causes adrenalin release) include weakness, sweating, tachycardia, palpitations, and hunger.
• Symptoms may be present from 1 week to as long as several decades prior to the diagnosis (1 mo to 30 y, median 24 mo, as found in a large series of 59 patients).
• Symptoms may occur most frequently at night or in the early morning hours.
• Hypoglycemia usually occurs several hours after a meal.
• In severe cases, symptoms may develop in the postprandial period. Symptoms can be aggravated by exercise, alcohol, hypocaloric diet, and treatment with sulfonylureas.
• Weight gain occurs in 20-40% of patients. Because of hyperinsulinism, many patients may be overweight.
• Presence of symptoms of hypoglycemia 
• Documented low blood sugar at the time symptoms are present
• Reversal of symptoms by glucose administration.

Yeah, I haz those.  Did you see the little party I threw over here?  A DIAGNOSIS?  Could you imagine? Could THIS explain EVERYTHING?!  MAYBE.

 

But, I know, I know, it might not have a damn thing to do with my pancreas.  

I may simply just have reactive hypoglycemia, and I might just simply have seizures, etc.  But wouldn't it be lovely to connect dots?

 

And, I swear, if the dots get connected, and it turns out that my self-diagnosis circa 2006/2007 was CORRECT?  I want my MD, retroactive, and about four years back, please.  And then?  For repayment -- I want answers for all 116 people on my seizure registry. There's GOT to be something to this.

PS.  Read this, holy **** right?  *thud*  (You have to read my archives.  It's ALL there.)

Share on Facebook • Stumble It! • Subscribe to this feed