Glucose Management during Insulinoma Resection Using Real-Time Subcutaneous Continuous Glucose Monitoring

Abstract

Insulinoma is a rare neuroendocrine tumor that causes hypoglycemia due to unregulated insulin secretion. Blood glucose management during insulinoma resection is therefore challenging. We present a case in which real-time subcutaneous continuous glucose monitoring (SCGM) in combination with intermittent blood glucose measurement was used for glycemic control during surgery for insulinoma resection. The SCGM system showed the trends and peak of interstitial glucose in response to glucose loading and the change of interstitial glucose before and after insulinoma resection. These data were helpful for adjusting the glucose infusion; therefore, we think that an SCGM system as a supportive device for glucose monitoring may be useful for glucose management during surgery.

Pancreatic neuroendocrine neoplasms: The latest surgical and medical treatment strategies based on the current World Health Organization classification

“…Thus, if insulinoma is small and solitary, minimally invasive (laparoscopic/robot-assisted) pancreatic surgery (enucleation or distal pancreatectomy) could be considered in high volume centres specializing in this laparoscopic procedure [20,21,[23][24][25]. Real-time subcutaneous continuous glucose monitoring during surgery would be useful to determine if insulinoma is resected completely and hyperinsulinemia disappear [26].…”

Insulinoma presenting as hypoglycemia during lactose tolerance testing: a case report

“…There is a shifting trend toward outpatient evaluation of patients with symptomatic hypoglycemia using a prolonged overnight fast with repeat morning glucose measurements and formal testing for insulin and C-peptide levels once the glucose level is low [6]. The use of continuous glucose monitoring has also received recent attention for its potential role in the diagnosis and management of insulinoma, including its utility in revealing hypoglycemia unawareness [7], during pregnancy [8], and for perioperative glucose monitoring during surgery [9]. In our case, the patient had successful outpatient biochemical testing that obviated the need for an inpatient stay or continuous glucose monitoring.…”

Error traps in the perioperative management of children with type 1 diabetes

“…Data related to intraoperative CGM use are limited to small studies and case reports. CGM data may be particularly useful in operations in which tight glucose control is necessary, as glucose trends can be detected earlier than with intermittent glucose sampling 26,27 . In patients undergoing major surgery, arterial and capillary glucose samples are strongly correlated with each other 28 .…”

“…CGM data may be particularly useful in operations in which tight glucose control is necessary, as glucose trends can be detected earlier than with intermittent glucose sampling. 26,27 In patients undergoing major surgery, arterial and capillary glucose samples are strongly correlated with each other. 28 Intraoperative CGM and capillary glucose trends correlate well with each other, though CGM values may overestimate capillary values by up to 20 mg/dL.…”