Insulinoma

I had my surgery 3 yrs. ago this December. Lately my sugars go really low often during the day and always when I am exercising. I am no longer on any diabetic meds. I exercise with a group of other diabetics sponsored by our hospital and with qualified help. They mentioned insulinoma as a possibility. I can't believe it is my diet. I have taken the nutrition classes and feel that I am doing well with my diet. Anyone else have this problem? I have a call in for my diabetic doc but maybe I should be calling my surgeon as it is supposed to be some kind of pancreatic tumor. Would appreciate any info on this.

Insulinoma is an extraordinarily rare tumor, is almost always benign, but can rarely become malignant. The vast majority of hypoglycemia cases are not insulinoma. As a PCP myself, I have always thought of it in patients with documented hypoglycemia, but have never found one. An endocrinologist is the correct specialist to see in regard to a possible insulinoma. One method of diagnosing an insulinoma is to put a patient in the hospital and fast them. By measuring glucose frequently we will see a steady decline in glucose over a period of hours that will NOT improve without feeding or giving IV glucose. This is an older method and there are newer less dramatic methods. The vast majority of time, the problem is carbohydrate hypersensitivity in which meals with significant carbs cause an innapropriate overrelease of Insulin, bringing on a temporary glucose drop which will improve essentially on its own due to counter-regulatory hormones which push your sugar up. Eating a SMALL amount of carbs (like a glucose tab) when you feel like this will improve the way you feel more quickly. There have been reports in a few (38 I believe nationwide) WLS patients of sudden and severe blood glucose drops which are due to a similar excess Insulin release reaction. I believe this problem is treated with more frequent & smuch maller servings of complex carbs throughout the day. However, some of the patients suffered such severe low blood sugar episodes that they lost consciousness, became delirious, and even experienced symptoms like tunnel vision. They became so incapacitated when these episodes occured thay couldn't be left alone or allowed to drive. I suspect they needed reversals, but I am not certain how they were treated. Hope this helps. It is highly unlikely that you have an Insulinoma, but it is good someone thought of it, otherwise we might miss them. There is a saying in Internal Medicine that rings true. "When you hear hoofbeats, its probably horses you'll find, not zebras. Insulinoma is a true zebra! Ask your PCP to refer you to an Endocrinologist to work this out. Dr. Marcus R Williams General Internal Medicine