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Cited by 9Neuroendocrine Tumor Research AdvancesPancreatic function and diabetesDiabetes Management and Research

Managing Hypoglycaemia in Patients With Insulinoma—A Tertiary Centre Experience and Review of the Literature

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Howarth, Sophie, Ho, Tak‐Wai, Wimbury, James, Casey, Ruth·2025·Clinical Endocrinology
DOI 10.1111/cen.15188PMC PMC11788970
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Abstract

The management of hypoglycaemia is pivotal in the care of patients with insulinoma. Blood glucose monitoring and regulation needs careful attention pre‐ and peri‐operatively for patients undergoing surgical resection and as part of the long‐term management for patients with inoperable or metastatic disease. Hypoglycaemia symptoms are frequently pervasive and disabling, with many patients showing impaired hypoglycaemia awareness that can lead to life‐threatening severe hypoglycaemia. Herein, we review the literature and describe our tertiary centre experience in the mutli‐disciplinary management of hypoglycaemia for patients with proven insulinomas. We propose a stepwise algorithm for the management of hypoglycaemia, stratified by localised versus metastatic disease. We discuss our strategy for the nutritional management of hypoglycaemia, reviewing the evidence for the use of cornstarch products and artificial nutrition. We discuss pharmacological management including diazoxide, somatostatin receptor antagonists (SSAs), everolimus and glucocorticoids, in addition to other therapeutic interventions such as peptide receptor radionuclide therapy (PRRT) and endoscopic ablation.

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  • Everolimus downregulates insulin secretion by inhibition of the mTORC1/S6K pathway with subsequent improvement in hypoglycemia observed within 3-14 days of starting treatment.

    “Everolimus was found to downregulate insulin secretion by inhibition of the mTORC1/S6K pathway with subsequent improvement in hypoglycemia observed within 3-14 days of starting treatment [92].”

    From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [92]

  • SSTR2 agonists such as octreotide and lanreotide reduce hypoglycemia and assist with tumor regression in insulinomas.

    “As insulinomas are known to express SSTR2, SSTR2 agonists such as octreotide and lanreotide have not only been shown to reduce hypoglycemia but also assist with tumor regression [92].”

    From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [92]

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Cited by

Sorted by citations

Authors
Howarth, S., Ho, T., Wimbury, J., & Casey, R.
Affiliations
  • University of Cambridge (GB)
  • Cambridge University Hospitals NHS Foundation Trust (GB)
Corresponding author
Casey, Ruth
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2024-12-30
Volume
102
Issue
3
Pages
344-354
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/cen.15188
PMC
PMC11788970
OpenAlex
W4405952648
Cited by
9
References
1
Citations by year
2026: 4 · 2025: 5
FWCI
0.59
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Endocrinology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
insulinoma, hypoglycemia management, hypoglycemia awareness, blood glucose monitoring, surgical resection, metastatic insulinoma, corn starch, artificial nutrition, diazoxide, somatostatin receptor antagonists, everolimus, glucocorticoids, peptide receptor radionuclide therapy, endoscopic ablation, management algorithm
MeSH terms
Blood Glucose, Female, Humans, Hypoglycemia, Insulinoma, Male, Middle Aged, Pancreatic Neoplasms, Tertiary Care Centers

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