Tuesday, January 10, 2012

Hypoglycemia and I suffer with it....Alok


What are the key symptoms?
The tumours are associated with episodes of low blood sugar (hypoglycemia) that can cause an array of symptoms.
Low blood sugar levels can affect the central nervous system (the brain) causing episodes or attacks of confusion, panic attacks, and even personality change.
The insulin producing tumours can also affect the autonomic nervous system (that controls many of the organs, muscles, and systems in the body, such as heart rate) causing palpitations, sweating and a trembly feeling.
Patients with an insulinoma will find eating or drinking something sugary can quickly alleviate their symptoms.

Low blood sugar levels caused by the tumour can trigger:
  • Confusion, anxiety, personality disorders and even aggressiveness
  • Rapid heartbeat, sweating, palpitations, feelings of hunger, dizziness and drowsiness. You may look pale, (or grey if you have a dark skin), have a headache feel irritable, feel faint and suddenly weak
  • If blood sugar drops very low or very suddenly it is possible to lose consciousness and it can even lead to seizures (fits)
·         What is an insulinoma?
·         Insulinomas are rare type of functional neuroendocrine tumours with an incidence estimated at 1 to 4 new cases per million persons per year. They are called functional because they produce insulin and cause blood sugar levels, to drop.
·         Insulinoma is one of the most common types of tumour arising from the islets of Langerhans cells (pancreatic endocrine tumours).
·         Estimates of malignancy (metastases) range from 5% to 30%. Over 99% of insulinomas originate in the pancreas, with rare cases from ectopic pancreatic tissue.
·         About 5% of cases are associated with tumours of the parathyroid glands and the pituitary (Multiple endocrine neoplasia type 1) and are more likely to be multiple and malignant. Most insulinomas are small, less than 2 cm.
·         The most common symptoms of insulinomas are confusion, sweating, dizziness, weakness and relief with eating. These symptoms are caused by low blood sugar known as hypoglycemia.
·         There can often be a delay in the diagnosis due to the vague and varied symptoms that these tumours can cause.
·         Most insulinomas are solitary and benign and therefore surgical resection can often result in a cure, but there is a proportion of insulinomas that become malignant so it is vital that the correct diagnostic techniques are used.
·         The role of the pancreas
·         In a healthy person the pancreas produces both insulin and glucagon. When blood sugar rises after a meal, beta cells in the pancreas release insulin. This helps sugar from food to enter the blood cells and lowers levels of glucose to normal.
·         If blood sugar falls too low then alpha cells in the pancreas produce glucagons that triggers the liver to release glycogen. This is converted into blood glucose, thereby lifting levels of blood sugar to normal.
·         What is known about insulinomas?
·         In most cases a single tumor develops in the beta cells (the insulin producing cells) within the pancreas. In a very small number of cases (1-3%) the tumour will develop in insulin producing cells that have 'escaped' into the abdomen. The reason why tumours form is not yet fully understood. They may be present form many years prior to diagnosis as the symptoms they cause may be confused with other conditions.

Signs and symptoms

Hypoglycemic symptoms and manifestations can be divided into those produced by the counterregulatory hormones (epinephrine/adrenaline and glucagon) triggered by the falling glucose, and the neuroglycopenic effects produced by the reduced brain sugar.

[edit] Adrenergic manifestations

[edit] Glucagon manifestations

[edit] Neuroglycopenic manifestations

  • Abnormal mentation, impaired judgment
  • Nonspecific dysphoria, moodiness, depression, crying, exaggerated concerns
  • Negativism, irritability, belligerence, combativeness, rage
  • Personality change, emotional lability
  • Fatigue, weakness, apathy, lethargy, daydreaming, sleep
  • Confusion, amnesia, dizziness, delirium
  • Staring, "glassy" look, blurred vision, double vision
  • Flashes of light in the field of vision
  • Automatic behavior, also known as automatism
  • Difficulty speaking, slurred speech
  • Ataxia, incoordination, sometimes mistaken for "drunkenness"
  • Focal or general motor deficit, paralysis, hemiparesis
  • Paresthesia, headache
  • Stupor, coma, abnormal breathing
  • Generalized or focal seizures
Tips on how to manage Hypoglycemia
Hypoglycemia, or hypo, is the medical term for low blood glucose levels – that is a blood glucose level of less than 4 mmol/l. This is too low to provide enough energy for your body’s activities. Hypos are one of the most common symptoms of having an insulinoma. It is caused because the insulinoma produces insulin.
What causes a hypo? A hypo can be caused by the following:
· too much insulin
· a delayed or missed meal or snack
· not enough food containing carbohydrate
· Unplanned or strenuous activity
· drinking too much alcohol or alcohol without food
· sometimes there is no obvious cause
Signs of a mild hypo
Most people have some warning signs when their blood glucose level starts to go low. These include:
· feeling hungry
· trembling or shakiness
· sweating
· anxiety or irritability
· going pale (grayish complexion if you are Black)
· fast pulse or palpitations
· tingling of the lips
· blurred vision.
Signs of a more severe hypo
· difficulty in concentrating
· vagueness or confusion
· irrational behavior.
Immediate treatment
Once you notice your hypo warnings, take action quickly or it is likely to become more severe, and you may become unconscious or have a fit. Immediately treat with a 10-20g of a short-acting carbohydrate such as:
· a glass of Lucozade or non-diet drink
· three or more glucose tablets
· five sweets, eg jelly babies
· a glass of fruit juice
The exact quantity will vary from person to person.
· If your hypo is more severe and you cannot treat it yourself, someone else can help you by: applying GlucoGel (or treacle, jam or honey) on the inside of your cheeks and gently massaging the outside of your cheeks.
· If you are unconscious, Glucagon can be injected if the person you are with has been trained to use it. Otherwise the people you are with should call an ambulance immediately.
Important: If you are unable to swallow or unconscious, you should not be given anything by mouth (including GlucoGel, treacle, jam or honey). Make sure your family and friends are aware of this. If you are unconscious, you should be placed in the recovery position (on your side with your head tilted back) so that your tongue does not block your throat.
Follow-on treatment
To prevent your blood glucose levels dropping again, you should follow your sugary foods with 10-20g of a longer-acting carbohydrate such as:
· half a sandwich
· fruit
· a small bowl of cereal
· biscuits and milk
· the next meal if due.

The exact quantity will vary from person to person.
Hypos at night
If you are concerned about night-time hypos, check your blood glucose between 2am and 3am when hypos are most likely to happen. Keep something sugary by your bed just in case. Alternatively have a snack before bed-time such as biscuits and milk, half a sandwich, fruit or yoghurt. If you blood glucose is low before going to bed ensure that you eat to raise your levels.
Hypos and physical activity
Physical activity lowers your blood glucose level so it is important to eat some form of carbohydrate before, possibly during and after your activity especially if it is strenuous or lasts a long time. Hypos can happen up to 36 hours after strenuous or prolonged physical activity so you might need to adjust your medication or carbohydrate intake to compensate.
Hypos and driving
Always test your blood glucose levels before driving. If you feel you may be going hypo, pull over, stop the car as soon as it is safe to do so and remove the keys from the ignition. Leave the driving seat and treat your hypo in the usual way. Do not attempt to start driving again until you are sure your blood glucose levels have risen again.
Hypos and alcohol
Drinking a lot of alcohol or drinking on an empty stomach makes a hypo more likely to occur. The outwards signs of a hypo are also very similar to those of being drunk. Always have something to eat if you are drinking alcohol, and tell the people you are with about your diabetes and what to do if you need help treating a hypo.
Important points to remember:
· Always have something sugary with you for use in an emergency.
· Wear some medical I.D.
· Tell your friends or family what signs you have when you go hypo and how to treat it, as you may not be able to think clearly when your blood glucose goes low.
· You will come to recognise your own hypo warning signs, but these may change over time, so be prepared to check your blood glucose level if you experience any unusual symptoms.
This information is from 9825/0110/a ©Diabetes UK 2010 it was produced in relation to hypos for diabetics. It has been reproduced here as it is perhaps the best advice currently available for managing and treating hypoglycemia for those with an insulinoma. 

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