Determination of insulin for the diagnosis of hyperinsulinemic hypoglycemia
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Hyperinsulinemic hypoglycemia is the most common cause of persistent hypoglycemia in children and adults. The diagnosis of hyperinsulinemic hypoglycemia relies on the evaluation of the biochemical profile at the time of hypoglycemia, however, contrary to common perception, plasma insulin is not always elevated. Thus, the diagnosis must often be based on the examination of other physiologic manifestations of excessive insulin secretion, such as suppression of glycogenolysis, lipolysis and ketogenesis, which can be inferred by the finding of a glycemic response to glucagon, and the suppression of plasma free fatty acids and beta-hydroxybutyrate concentrations during hypoglycemia.
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Plasma insulin concentration is sometimes not above the lower limit of detection in hyperinsulinism.
“Because plasma insulin concentration is sometimes not above the lower limit of detection,34 it is important to include the following tests when assessing the possibility of hypoglycemia due to hyperinsulinism: plasma BOHB and FFA (both inappropriately low; BOHB <1.5 mmol/L [<15 mg/dL] and FFA <1.0–1.5 mmol/L [<28–42 mg/dL]), and an increased glycemic response to glucagon.”
From Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children (2015) · cites this paper as [34]
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de Herder, W. W. (2015) · Springer eBooks · doi:10.1007/978-3-319-17235-4_4
- Authors
- De León, D. D., & Stanley, C. A.
- Affiliations
- Children's Hospital of Philadelphia (US)
- Corresponding author
- Stanley, Charles A.
- ORCID
- Stanley, Charles A.
- Venue
- Best Practice & Research Clinical Endocrinology & Metabolism
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 27
- Issue
- 6
- Pages
- 763-769
- ISSN
- 1521-690X (ISSN-L)
- PMC
- PMC4141553
- OpenAlex
- W2031515197
- Cited by
- 63
- References
- 33
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 5 · 2020: 8 · 2019: 4 · 2018: 2 · 2017: 5 · 2016: 4 · 2015: 9 · 2014: 5
- FWCI
- 1.06
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Best Practice & Research Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000003)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK053012, R37DK056268)
- National Center for Research Resources (UL1RR024134)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- hyperinsulinemic hypoglycemia, insulin measurement, hypoglycemia diagnosis, insulin secretion, glucagon stimulation test, free fatty acids, beta-hydroxybutyrate, plasma insulin
- MeSH terms
- Blood Glucose, Glucagon, Humans, Hyperinsulinism, Hypoglycemia, Insulin
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