Assessment of hyperinsulinaemia at the termination of the prolonged fast

Wiesli, Peter; Brändle, Michael; Zapf, J.; Seiler, Heidi; Zwimpfer, Cornelia; Spinas, Giatgen A.; Schmid, Christoph

doi:10.1016/j.cccn.2003.12.023

Cited by 15 publications

(8 citation statements)

References 19 publications

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“…In cases with milder symptoms or in patients in whom hypoglycemia is not documented, a 72 h prolonged fasting is advocated to induce hypoglycaemia. [ 8 9 ] In our series four cases underwent prolonged fasting and developed hypoglycemia within 24 h, compared to another series in which during 72 h prolonged fast all cases attained hypoglycemia within 48 h.[ 10 ] Our experience in localizing insulinomas with different imaging modalities is similar to other series. [ 11 12 13 14 15 16 ] In a series of 31 insulinoma patients, the symptom profile of patients was similar to our cases.…”

Section: Discussionsupporting

confidence: 67%

Insulinoma case series: Experience of a tertiary care center

Anakal

Kalra

Dharmalingam

et al. 2014

Indian J Endocr Metab

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Background:Insulinomas are usually solitary; benign and encapsulated small lesions and majority of them measure <2 cm in diameter. They pose a challenge for pre-operative localization. Definitive treatment is surgical excision of the tumor. Intra-operative ultrasonography (IOUS), transhepatic portal venous sampling (THPVS) and positron emission tomography (PET) scan can be done for tumors not localized by conventional imaging modalities.Materials and Methods:A retrospective study of patients diagnosed with insulinoma during the period 2004-2012 (8 years) was done. Biochemical diagnostic criteria used were plasma concentrations of glucose <55 mg/dl with corresponding insulin level >3.0 μU/ml (18 pmol/L) and C-peptide of >0.6 ng/ml (0.2 nmol/L). The localization of the tumor was done by various modalities namely computed tomography (CT), magnetic resonance imaging (MRI), IOUS, PET and portal venous sampling. The initial localizing technique in most of these patients were CT or MRI imaging, or both and those who were not localized by the above modalities were subjected to PET CT or THPVS or intra-operative ultrasound depending on the initial imaging results and patient's consent. All the modalities were not used in the same patient, but the modalities were decided as per the imaging results, patient's consent and affordability for the procedure.Results:Ninteen cases of insulinoma aged between 10 and 66 years, with a median age of 47 years were included in the analysis. There were 10 males and nine females. Eighty-three percent of patients presented with pre-prandial hypoglycemia (n = 15). Different modalities were employed for pre-operative localization of these patients out of which 5 (26.31%) cases were localized with CT, 5 (26.31) cases with MRI, 5 (26.31%) with THPVS, 1 (5.26%) case with PET CT, 3 (15.78%) of them could not be localized out of which 2 (10.52%) were localized by IOUS and 1 (5.26%) case the lesion could not be localized. Among 19 cases, 12 underwent surgery out of which one patient underwent distal pancreatectomy as tumor was not localized; eight underwent laparoscopic enucleation; three of them required intra-operative exploration and seven of them were not operated, as they did not give consent for surgery. In all the cases, the size of the insulinoma ranged between 1 and 2 cm.Conclusion:We report our experience with 19 cases of insulinoma and analyze the role of pre- and intra-operative imaging modalities in the surgical management of insulinomas. Most of our cases were symptomatic, and the most common presentation was with pre-prandial hypoglycemia. THPVS, PET scan and intra-operative ultrasound added to diagnostic sensitivity in some cases not localized by CT or MRI.

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Section: Discussionsupporting

confidence: 67%

Insulinoma case series: Experience of a tertiary care center

Anakal

Kalra

Dharmalingam

et al. 2014

Indian J Endocr Metab

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“…Healthy individuals generally have the ability to manage without food for 24-48 h without any remarkable changes in blood glucose level (Wiesli et al, 2004(Wiesli et al, , 2005. In case of depressed food intake during longer periods, the human body has several systems to provide additional energy such (174) 119 (81) 143 (122) 348 (166) 429 (200) 314 (183) 366 (256) 430 (402) Glucagon (pmol/l) 42 (7) 40 (6) 34 (5) 34 (6) 33 (6) 33 (6) 35 (6) 36 (7) Resistant group, n ¼ 8…”

Section: Discussionmentioning

confidence: 99%

“…Thus, there is a virtual difference between these two groups of apparently healthy subjects. In general, healthy individuals are considered to be capable of maintaining normoglycemia under prolonged fasting (Wiesli et al, 2004(Wiesli et al, , 2005.…”

Section: Introductionmentioning

confidence: 99%

Effect of fasting on young adults who have symptoms of hypoglycemia in the absence of frequent meals

2007

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Background and Objectives: Among otherwise healthy adults, there is a subgroup of individuals who develop symptoms of hypoglycemia during episodes of food restriction. The aim of the present study was to investigate whether such individuals develop hypoglycemia or react abnormally in other metabolic aspects during a 24-hour fast. Subjects and Methods: Ninety medical students were asked if they wanted to participate. Sixteen were selected; none dropped out. A 24-hour fast was performed at a hospital ward. Blood samples and questionnaires were taken at eight specific times. Result: During the fast, the sensitive group reported significantly higher scores on 'irritation' and 'shakiness'. However, no hypoglycemia occurred and the lowest detected blood glucose concentration was 3.7 mmol/l. There were no differences between the groups in plasma glucose, cortisol, growth hormone (GH), insulin, b-hydroxybutyrate (b-OH) and lactate levels. The blood pressures and heart rates were also similar. Conclusions: Adults, despite subjective signs of hypoglycemia, can fast without any metabolic or endocrine derangement.

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“…In addition, plasma samples were screened for first-and second-generation sulphonylureas to rule out factitious hypoglycaemia. The biochemical results (insulin, C-peptide, proinsulin and b-hydroxybutyrate concentrations) at the termination of the fast of 11 patients with hypoglycaemic disorders and 18 healthy individuals have been shown previously (9).…”

Section: The 72-h Fastmentioning

confidence: 68%

Mini-Mental State Examination is superior to plasma glucose concentrations in monitoring patients with suspected hypoglycaemic disorders during the 72-hour fast

Wiesli¹,

Schwegler²,

Schmid³

et al. 2005

eur j endocrinol

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Systematic evaluation of cognitive function by the MMSE at the beginning and at the termination of the fast allows objective determination and documentation of the deterioration of the cognitive state in patients with hypoglycaemic disorders. A decline in the cognitive performance by > or =6 points in the MMSE score rather than a distinct plasma glucose concentration should be used as the criterion to terminate the prolonged fast before 72 h.

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Assessment of hyperinsulinaemia at the termination of the prolonged fast

Cited by 15 publications

References 19 publications

Insulinoma case series: Experience of a tertiary care center

Insulinoma case series: Experience of a tertiary care center

Effect of fasting on young adults who have symptoms of hypoglycemia in the absence of frequent meals

Mini-Mental State Examination is superior to plasma glucose concentrations in monitoring patients with suspected hypoglycaemic disorders during the 72-hour fast

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