Hypoglycemia results from an excess of insulin action relative to blood glucose.
Increased glucose utilization during exercise can lead to hypoglycemia during, and for many hours following, a workout.
In addition, there is an attenuated sympathetic response, primarily involving epinephrine, which is largely responsible for the development or worsening of impaired hypoglycemia awareness.
0%) are appropriate include patients with a history of severe hypoglycemia, limited life expectancy, advanced micro-or macrovascular complications, extensive comorbidities, and those with long-standing DM in whom the A1C target is difficult to attain despite aggressive intervention.
Glucose-lowering agents are a common cause of hypoglycemia, with some agents more likely to produce hypoglycemia than others (TABLE 2).
The remaining classes of glucose-lowering agents--alpha-glucosidase inhibitors, ergoline derivatives (eg, bromocriptine), bile acid sequestrants (eg, colesevelam), dipeptidyl peptidase-4 (DPP-4) inhibitots, glucagon-like peptide-1 receptor (GLP-1R) agonists, biguanides (eg, metformin), amylin analog (eg, pramlintide), and thiazolidinediones (TZDs)--are considered low-risk for hypoglycemia as they lower blood glucose by 1 or more mechanisms other than increasing the blood level of insulin, or work in a glucose-dependent manner.
31) Among insulins, the slower onset, delayed peak, and longer duration of action of regular human insulin results in an increased risk of hypoglycemia compared with the rapid-acting insulin analogs aspart, glulisine, and lispro.
Concern about hypoglycemia has been a factor in the development of new glucose-lowering medications.
We report the case of a patient in whom an insulinoma was diagnosed in the context of rapid weight loss and postprandial, rather than fasting, hypoglycemia.
A 56-year-old white male presented for evaluation of hypoglycemia.
The inappropriately elevated insulin level > 6 U/mL in the setting of a serum glucose concentration lower then 45 mg/dL indicated hyperinsulinemic hypoglycemia and further workup was performed.
This case is unusual in that the patient's hypoglycemia was associated with weight loss.
A second unusual feature of this case is that this patient had no nocturnal or early morning hypoglycemia or precipitation of hypoglycemia with exercise and presented with postprandial late-morning hypoglycemia.
In conclusion, we have described an unusual case of hyperinsulinemic hypoglycemia due to an insulinoma, the effects of which were precipitated by voluntary weight loss and lowering of insulin resistance.
Decreased epinephrine responses to hypoglycemia during sleep.