Hyperinsulinism 1089982 213499095 2008-05-19T16:50:30Z VolkovBot 3035831 robot Adding: [[pt:Hiperinsulinismo]] {{Infobox_Disease | Name = {{PAGENAME}} | Image = | Caption = | DiseasesDB = 20590 | ICD10 = {{ICD10|E|15||e|15}}, {{ICD10|E|16|1|e|15}} | ICD9 = {{ICD9|251.1}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = ped | eMedicineTopic = 1075 | MeshID = D006946 | }} '''Hyperinsulinism''' or '''hyperinsulinemia''' refers to an above normal level of [[insulin]] in the [[blood]] of a person or animal. Normal insulin secretion and blood levels are closely related to the level of [[glucose]] in the blood, so that a given level of insulin can be normal for one blood glucose level but low or high for another. Hyperinsulinism can be associated with several types of medical problems, which can be roughly divided into two broad categories: those tending toward reduced [[insulin sensitivity|sensitivity]] to insulin and high blood glucose levels ([[hyperglycemia]]), and those tending toward excessive insulin secretion and low glucose levels ([[hypoglycemia]]). ==Hyperinsulinism due to diminished sensitivity, associated with diabetes risk== Although many factors influence insulin secretion, the most important control is the amount of [[glucose]] moving from the blood into the [[beta cell]]s of the [[pancreas]]. In healthy people, even small rises in blood glucose result in increased insulin secretion. As long as the pancreatic beta cells are able to sense the glucose level and produce insulin, the amount of insulin secreted is usually the amount required to maintain a fasting blood glucose between 70 and 100 mg/dL (3.9-5.6 mmol/L) and a non-fasting glucose level below 140 mg/dL (<7.8 mmol/L). When [[liver]] cells and others that remove glucose from the blood become less [[insulin sensitivity|sensitive]] and more [[insulin resistance|resistant]] to the insulin, the pancreas increases secretion and the level of insulin in the blood rises. This increased secretion can compensate for reduced sensitivity for many years, with maintenance of normal glucose levels. However, if insulin resistance worsens or insulin secretion ability declines, the glucose levels will begin to rise. Persistent elevation of glucose levels is termed [[diabetes mellitus]]. Typical fasting insulin levels found in this type of hyperinsulinism are above 20 μU/mL. When resistance is severe, levels can exceed 100 μU/mL. In addition to being a risk factor for [[type 2 diabetes]], hyperinsulinism due to insulin resistance may increase [[blood pressure]] and contribute to [[hypertension]] by direct action on [[vascular endothelial cell]]s (the cells lining blood vessels). Hyperinsulinism has also been implicated as a contributing factor in the excessive production of [[androgen]]s in [[polycystic ovary syndrome]]. The principal treatments of hyperinsulinism due to insulin resistance are measures that improve insulin sensitivity, such as weight loss, physical exercise, and drugs such as [[thiazolidinedione]]s or [[metformin]]. ==Hyperinsulinism due to inappropriate secretion, associated with hypoglycemia== Hyperinsulinism is also used in medical contexts to refer to forms of hypoglycemia caused by excessive insulin secretion. In normal children and adults, insulin secretion should be minimal when blood glucose levels fall below 70 mg/dL (3.9 mM). There are many forms of [[hyperinsulinemic hypoglycemia]] caused by various types of insulin excess. Some of those that occur in infants and young children are termed [[congenital hyperinsulinism]]. In adults, severe hyperinsulinemic hypoglycemia is often due to an [[insulinoma]], an insulin-secreting tumor of the pancreas. Insulin levels above 3 μU/mL are inappropriate when the glucose level is below 50 mg/dL (2.8 mM), and may indicate hyperinsulinism as the cause of the hypoglycemia. The treatment of this form of hyperinsulinism depends on the cause and the severity of the hyperinsulinism, and may include surgical removal of the source of insulin, or a drug such as [[diazoxide]] or [[octreotide]] that reduces insulin secretion. Dr. [[Seale Harris]] first diagnosed hyperinsulinism in [[1924]] <ref name="liteforflife" >{{cite web|title=''Restore Your Health Safely and Sensibly''|work=Liteforlife.com|url=http://www.liteforlife.com/sealeharris.html|accessdate=2007-02-24}}</ref> and also is credited with the recognition of spontaneous [[hypoglycemia]].<ref name="alstatearchive" >{{cite web|title=''Seale Harris''|work=Alabama State Archives|url=http://www.archives.state.al.us/famous/s_harris.html|accessdate=2007-02-24}}</ref> ==Hyperinsulinism due to insulin injection== The treatment of [[diabetes mellitus]] with [[intensive insulin therapy|insulin replacement therapy]] can easily result in [[diabetic hypoglycemia]] due to the difficulty of balancing insulin delivery. Transient hyperinsulinism can also occur when insulin is injected by non-diabetic athletes attempting to enhance their [[anaerobic exercise|anaerobic]] performance. ==References== <div class="references-small"><references/></div> {{Endocrine pathology}} [[Category:Metabolic Disorder]][[Category:Endocrinology]] [[de:Hyperinsulinismus]] [[pt:Hiperinsulinismo]]