Hyperinsulinemia?

[cjsomar]

I have been diagnosed with hyperinsulinemia after a battery of tests on my heart because of tachycardia episodes.  A glucose tolerance was done and 1 hour after a 100g glucose charge, my levels were normal.  I don't know very much about this condition but I have a few questions.
My brief history: 19 y/o male.  Overweight.  Cholesterol normal 120 LDL.  No diabetes / previous medical problems.
1. I have read that this may be caused by cancer of the pancreas.  Would there be a low chance of that in me considering my only symptom was tachycardia?  No weight change, no seizures, headaches, etc.
2.  What tests would be recommended in order to rule out any other problems of the pancreas?
3.  Is it likely that this condition could be caused simply by being overweight?
4.  What treatments are available for hyperinsulinemia and does it often lead to diabetes if there is no intervention?

Thank you.
Chris

[Kevin Pho, MD]

There should be more tests done to make the diagnosis of hyperinsulinemia.  A normal blood glucose concentration measured during an episode of symptoms, whether postprandial or fasting, eliminates the need for further evaluation.  An oral glucose tolerance test is not an adequate test for this condition because the results are misleading in this situation.  The test of choice would be measurement of glucose during a prolonged fast.

Plasma glucose, insulin, C-peptide, and proinsulin should all be measured during a prolonged fast to fully evaluate whether hyperinsulinemia is present.  

To address your questions:
1) I cannot comment on whether you have insulinemia or not without more testing.  With tachycardia as the only symptom, there are many things more likely than an insulinoma.

2) I would recommend those blood tests I mentioned above.  A CT scan should be able to visualize pancreatic masses.

3) It is possible, but without examining you myself I cannot be sure.

4) Hyperinsulinemia leads to low blood sugars, not diabetes (i.e. high blood sugars).  The tests I mentioned above during a prolonged fast would be my recommendation to evaluate for this.  This should be done in conjunction wtih an endocrine specialist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

insulin lowers blood sugar by making it go into cells; so hyperinsulinemia causes low blood sugar. The test you report didn't show that, at least based on the results you mentioned. One would have expected the sugar level to be abnormally low after a couple of hours. Hyperinsulinemia can be caused by various things; cancer of the pancreas isn't really one of them. There is a non-cancerous tumor of the pancreas, called an insulinoma, that can do it. If a person is diagnosed with demonstrated abnormally low blood sugar, along with high levels of insulin, testing for that tumor is one of the things that is done. There are also genetic causes; babies are born with it and usually develop severe problems after birth; so it's unlikely you have that. In fact, it's not highly likely you actually have hyperinsulinemia; I'd suggest being sure you understood correctly what you were told. It's possible that on an occasion you or anyone could develop low blood sugar, which could cause various symptoms. That's different from a chronic situation of always having elevated insulin levels.

[Kutipi]

I was also diagnosed with this disorder.  In my case they are stating that it started in childhood.  I spent most of my childhood and teen years with severe hypoglycemia.  I then had gestational diabetes with both children.  I have lost my gall bladder which they stated was related.  The final diagnosis was done after a fasting glucose test and a seperate insulin measure.  My fasting glucose was 106 but my insulin measurement was 126 slightly above the upper 118 level.  I am also now dealing with insulin resistance and obesity.  I am wondering what dietary measurements should be used to reverse the effects of these disorders so that I can indeed lose the weight and maintain a healthy weight to ward off as long as possible the impending diabetes which I am told will be the result when the pancreas decides enough is enough.