Hyperinsulinism is defined by insulin secretion above normal. Untreated, it increases the risk of cardiovascular diseases.
Hyperinsulinism is characterized by excessive insulin secretion, most often secondary to metabolic syndrome. We speak of hyperinsulinism when the fasting blood insulin level is greater than 15 mIU/mL.
What are the causes ?
“Hyperinsulinism can be of genetic origin (rare diseases), be linked to an inadequate carbohydrate or caloric intake, to an greater calorie intake than normal or to stimulation of the pancreas in uteroinforms Dr Olivier Dupuy. If the mother’s blood sugar is high (gestational diabetes or “true” diabetes), the fetus will produce excess insulin. THE newborn at birth is more fragile and risks hypoglycemia since it produces too much insulin. Ultimately, this excess insulin puts you at risk of being overweight or even obese.“. Insulin resistance (when glucose can no longer enter cells to be used as an energy source despite persistent insulin secretion) also represents a cause of hyperinsulinism. More rarely, a pancreatic tumor can cause hyperinsulinism.
What are the symptoms ?
In the newborn, hyperinsulinism is mainly manifested by a macrosomia (baby who weighs more than 4kg at term) and possibly hypoglycemia. “In adults, hyperinsulinism is often asymptomatic. It can also manifest as a metabolic syndromenamely: an increase in waist circumference, high blood pressure, dysglycemia (moderate fasting hyperglycemia or diabetes) and abnormal lipid parameters, often associated with other diseases such as NASH or PCOS“, specifies the endocrinologist.
The diagnosis is based on the blood sugar measurement and very simply by waist measurement. “On the other hand, plasma insulin is rarely measured because it is a test that is not very reliable and expensive. Measuring waist circumference is the simplest, most reliable and most economical tool for detecting hyperinsulinism and, by extension, metabolic syndrome.comments the specialist.
What are the treatments ?
At birth, severe hypoglycemia must be treated urgently. The treatment is based on continuous glucose administration via glucagon infusion and injection to stabilize insulin secretion. As first intention, diazoxide is used. In case of resistance to this molecule, octreotide is added. These are exceptional treatments for rare situations. Thereafter, blood glucose should be monitored daily by sensor if possible. Subsequently, the usual treatment of hyperinsulinism is essentially based on healthy living. It involves in particular respecting a specific diet, lower in calories and low in rapidly absorbed sugars. Physical activity is a major element of treatment. “Hyperinsulinism is problematic because it constitutes a reflection of visceral fat which is harmful to healthparticularly in that it is correlated with the increase in cardiovascular risk“, concludes our interlocutor.
Thanks to Dr Olivier Dupuy, head of the endocrinology and diabetology department at Paris Saint-Joseph hospital.