Recurrent hypoglycemia
Article Abstract:
The case report is presented of a patient with recurrent hypoglycemia (abnormally low blood sugar), which continued even after the removal of a pancreatic tumor and, in a second operation, removal of much of the pancreas and the spleen. The 34-year-old man suffered confusion during the hypoglycemic episodes, had high levels of insulin (hyperinsulinemia), and developed a neuropathy (nerve disorder) that caused shaking, weakness, and muscle wasting. A discussion is presented of hypoglycemia and its symptoms. The majority of people complaining of fatigue, shakiness, sweating, and emotional lability are not, in fact, hypoglycemic. This case, however, appeared genuine. The problem-solving steps taken by the physician in establishing a diagnosis are outlined. Observation of a patient's insulin and glucose levels after a 72-hour fast can indicate whether an insulin-secreting tumor is present. In such cases, blood glucose levels continue to fall, but the drop in immunoreactive insulin levels that usually takes place when glucose falls does not occur. The patient demonstrated this pattern, however, investigation of the liver and remaining pancreas did not reveal a tumor. There were signs that a source of excess insulin was located in the head of the pancreas, though, and a laparotomy (surgical opening of the abdomen) was performed. An insulin-secreting mass was discovered, and its removal necessitated complete removal of the pancreas and part of the duodenum (the first part of the small intestine). The patient became an insulin-dependent diabetic, but was troubled with hypoglycemia no longer. Evaluation of both tumors removed from the patient indicated that first a glucagon-secreting tumor (glucagon is a hormone whose actions counteract those of insulin) and then an insulin-secreting tumor were removed. The appearance of severe fasting hypoglycemia with changes in mental status indicates that an insulinoma (insulin-secreting tumor) is probably present. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1990
User Contributions:
Comment about this article or add new information about this topic:
When does diabetes start?
Article Abstract:
Diabetes often leads to specific complications, including disease of the nervous system, the kidneys, and the retina of the eye. Another complication of diabetes is the development of cardiovascular disease at a faster rate than would otherwise be expected. Much research has been done to clarify the apparent link between glycemic control and the development of these complications. Glycemic control refers to the extent to which blood sugars are maintained in the normal range through the use of diet, insulin or medications; 'poor control' is characterized by frequent or chronic high blood sugar. Researchers are still trying to understand how poor glycemic control and the development of complications may be related, and it appears that the relationships are probably complex. A study by Haffner et al. in the June 6, 1990 issue of The Journal of the American Medical Association addresses these issues by examining cardiovascular risk factors in a large group of people, some of whom later developed non-insulin-dependent diabetes. Those who became diabetic had greater risk for cardiovascular disease when they were in the prediabetic state than those individuals who did not develop diabetes. While there are many implications of these findings and many avenues to investigate, there is an important lesson to be learned. When a clinician evaluates a patient who seems a likely candidate for developing diabetes, it can be assumed that the patient is on the path to diabetes and also has important cardiovascular disease risk factors that should be addressed immediately. If these risk factors, typically moderate elevations in weight, blood pressure, and cholesterol, are aggressively treated, many such patients might avert the eventual progression to diabetes and heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1990
User Contributions:
Comment about this article or add new information about this topic:
Assessing glycemia in diabetes using self-monitoring blood glucose and hemoglobin A(sub 1c)
Article Abstract:
A study was conducted to examine the evidence underlying the use of self-monitoring of blood glucose (SMBG) and hemoglobin A(sub 1c) (HBA(sub 1c)) in assessing glycemia in diabetes. The two methods SMBG and (HBA(sub 1c)) help in management of blood glucose and may thereby lead to a significant reduction in morbidity and mortality related to diabetes.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 2006
User Contributions:
Comment about this article or add new information about this topic:
- Abstracts: Parental permission, information, and consent. Routine measurement of blood pressure in schoolchildren. Rapid anticonvulsant monitoring in an epilepsy clinic
- Abstracts: 'The hypermobility syndrome'. Assessment of bone in Ehlers Danlos syndrome by ultrasound and densitometry. Joint hypermobility and fibromyalgia in schoolchildren
- Abstracts: Six children with lead poisoning. Prevalence of lead exposure in a clinic using 1991 Centers for Disease Control and Prevention recommendations
- Abstracts: Ischaemic brain lesions diagnosed at birth in preterm infants: clinical events and developmental outcome. Withdrawal of life support in babies: deceptive signals
- Abstracts: Modeling HIV infectivity: must sex acts be counted? Modeling zidovudine therapy: a cost-effectiveness analysis