Insulinoma Presenting with Reactive Hypoglycemia: Evaluating the Effect of Tumor Resection via Continuous Glucose Monitoring

Kikuchi, Toru; Chujo, Daisuke; Takahashi, Kazuhisa; Takahashi, Nobuyuki; Tanno, Yuuki; Tonoike, Mie; Ihana, Noriko; Tsujimoto, Tetsuro; Tanabe, Akiyo; Kajio, Hiroshi

doi:10.2169/internalmedicine.8766-16

Cited by 13 publications

(12 citation statements)

References 20 publications

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“…First, hypoglycemia was detected with CGM, but not by laboratory test or by self‐monitoring of blood glucose. Conflicting data about the accuracy of CGM at low‐glucose levels have been reported. Second, details of clinical phenotypes were studied only in a proband in the present study.…”

Section: Discussionmentioning

confidence: 86%

Clinical and genetic analysis in a family with familial renal glucosuria: Identification of an N101K mutation in the sodium–glucose cotransporter 2 encoded by a solute carrier family 5 member 2 gene

Sada

Hidaka

Imaishi

et al. 2019

J of Diabetes Invest

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We report the identification of a mutation in the solute carrier family 5 member 2 (SLC5A2) gene, which encodes sodium-glucose cotransporter 2, in a family with familial renal glucosuria. The proband was a 26-year-old Japanese man referred to the diabetes division with repeated glucosuria without hyperglycemia. His mother, uncle and grandfather also had a history of glucosuria. A heterozygous missense mutation (c.303T>A: p.N101K) in SLC5A2 was identified in the patient and his mother, but not in 200 chromosomes from 100 healthy and unrelated individuals, or in 3,408 Japanese individuals in the Tohoku Medical Megabank. Furthermore, bioinformatics software predicted that this lesion would be pathogenic. We infer that the mutation led to clinically relevant sodium-glucose cotransporter 2 dysfunction. The patient showed no symptoms of hypoglycemia, but continuous glucose monitoring confirmed asymptomatic hypoglycemia.

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Section: Discussionmentioning

confidence: 86%

Clinical and genetic analysis in a family with familial renal glucosuria: Identification of an N101K mutation in the sodium–glucose cotransporter 2 encoded by a solute carrier family 5 member 2 gene

Sada

Hidaka

Imaishi

et al. 2019

J of Diabetes Invest

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“…CGM systems have been used in insulinoma cases with hypoglycemia unawareness [5][6][7]. However, CGM systems require frequent CBG-based calibrations, which can be a major obstacle to the use of CGM systems as a modality for identifying hypoglycemia in insulinoma cases with hypoglycemia unawareness.…”

Section: Discussionmentioning

confidence: 99%

“…One of the main causes of delay is hypoglycemia unawareness, which can obscure a patient's notice of hypoglycemia and worsen the outcomes [3][4][5]. In this context, continuous glucose monitoring (CGM) has been demonstrated to be a useful tool to detect hypoglycemia in cases of insulinoma with hypoglycemia unawareness [5][6][7]. However, most currently available CGM systems require calibration by frequent self-monitoring of capillary blood glucose (CBG) levels, and allow only a retrospective view of past hypoglycemic events, excepting a device equipped with a real-time CGM system [8].…”

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confidence: 99%

Factory-calibrated continuous glucose monitoring and capillary blood glucose monitoring in a case with insulinoma: usefulness and possible pitfall under chronic hyperinsulinemic hypoglycemia

et al. 2020

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The accuracy of factory-calibrated continuous glucose monitoring (fCGM) within hypoglycemic ranges, especially under the status of chronic hyperinsulinemic hypoglycemia like insulinomas, remains an issue. Even so, fCGM is known to be useful for detecting hypoglycemia unawareness in insulinoma cases. A 25-year-old woman presenting with sudden unconsciousness was diagnosed with insulinoma; fCGM facilitated diagnosis by continuous monitoring for hypoglycemia. Before surgery, she was treated with continuous and frequent bolus infusions of 50% glucose via central venous catheter. To evaluate the accuracy of fCGM values in this case, a comparison between fCGM and capillary blood glucose (CBG) values was also performed. According to the simultaneously measured values, those of fCGM were largely in accordance with those of CBG. Moreover, compared with the previously reported case not having glucose infusions via central venous catheter, both the mean absolute relative differences (MARDs) and the absolute differences (Δ glucose) between fCGM and CBG values were larger in the present case, although no significant differences of MARDs and Δ glucose between the two cases were observed in several different conditions including fasting, post-meal, hypoglycemia, and others. Therefore, we should note possible increased differences between fCGM and CBG values in cases using frequent intravenous glucose infusions as well as case-dependent differing levels of consistency between them.

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“…Postprandial hypoglycemia can occur among individuals following gastric bypass surgery by dumping syndrome 21 . Another potential cause of fasting or postprandial hypoglycemia is insulinoma, which can be difficult to diagnose and has a low incidence of 4 per 1 million individuals per year 22 …”

Section: Methodsmentioning

confidence: 99%

“…21 Another potential cause of fasting or postprandial hypoglycemia is insulinoma, which can be difficult to diagnose and has a low incidence of 4 per 1 million individuals per year. 22…”

Section: Glycemic Criteria Descriptionmentioning

confidence: 99%

Glucagon: Its evolving role in the management of hypoglycemia

et al. 2021

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More than 10% of the United States population has diabetes, characterized by hyperglycemia. Insulin and other agents used to treat diabetes predispose people to hypoglycemia, which can be life threatening. Glucagon is an emergency medication that can save lives by quickly raising glucose in people who are unconscious or unable to consume glucose due to severe hypoglycemia. Although glucagon has been commercially available since 1960, earlier formulations required reconstitution of a dry powder with diluent immediately prior to injection, due to lack of long-term stability once reconstituted. Glucagon has been underutilized due to the lack of confidence or ability to administer in emergency situations. More recently, new formulations including a nasal powder glucagon and liquid-stable glucagon have become available. This article discusses the evidence surrounding new glucagon formulations compared with the original glucagon emergency kit including ease of use, efficacy, and safety with a focus on important patient counseling points and relevant clinical information on hypoglycemia.

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Insulinoma Presenting with Reactive Hypoglycemia: Evaluating the Effect of Tumor Resection via Continuous Glucose Monitoring

Cited by 13 publications

References 20 publications

Clinical and genetic analysis in a family with familial renal glucosuria: Identification of an N101K mutation in the sodium–glucose cotransporter 2 encoded by a solute carrier family 5 member 2 gene

Clinical and genetic analysis in a family with familial renal glucosuria: Identification of an N101K mutation in the sodium–glucose cotransporter 2 encoded by a solute carrier family 5 member 2 gene

Factory-calibrated continuous glucose monitoring and capillary blood glucose monitoring in a case with insulinoma: usefulness and possible pitfall under chronic hyperinsulinemic hypoglycemia

Glucagon: Its evolving role in the management of hypoglycemia

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