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Hyperinsulinemic Hypoglycemia

A group of disorders characterized by inappropriate endogenous insulin secretion in the presence of hypoglycemia, including insulinoma, nesidioblastosis, post-bariatric syndromes, and autoimmune insulin syndrome.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Hyperinsulinemic Hypoglycemia?

Hyperinsulinemic hypoglycemia describes hypoglycemia driven by inappropriate endogenous insulin secretion, with elevated insulin and C-peptide levels and suppressed beta-hydroxybutyrate during a hypoglycemic episode.

Causes include insulinoma (sporadic or part of MEN1), non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS, nesidioblastosis), post-bariatric surgery hypoglycemia, factitious insulin or sulfonylurea use, and rarely insulin autoimmune (Hirata) syndrome.

Workup includes 72-hour supervised fasting, mixed meal testing, imaging with CT, MRI, and endoscopic ultrasound, and selective arterial calcium stimulation in selected cases to localize the lesion.

Symptoms

Recurrent symptoms of neuroglycopenia such as confusion, dizziness, behavioral changes, and seizures
Adrenergic symptoms including tremor, palpitations, sweating, and hunger
Episodes occurring during fasting, after exercise, or several hours after meals
Weight gain due to defensive overeating
Loss of awareness of hypoglycemia in long-standing disease

Risk Factors

Personal or family history of MEN1 syndrome
Prior bariatric surgery, especially Roux-en-Y gastric bypass
Access to insulin or sulfonylureas (factitious cases)
Other autoimmune diseases (Hirata syndrome, especially in patients of Asian descent)
Underlying pancreatic neuroendocrine tumor risk factors

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Repeated hypoglycemia episodes that resolve with carbohydrate intake
  • Hypoglycemia accompanied by neurological symptoms such as confusion or seizure
  • Severe hypoglycemia after bariatric surgery
  • Unexplained hypoglycemia in a non-diabetic patient — endocrinology referral

Treatment Methods

01
Confirmation with supervised 72-hour fast and biochemical demonstration of hyperinsulinemic hypoglycemia
02
Localization with multiphase pancreatic CT or MRI, endoscopic ultrasound, and selective arterial calcium stimulation when needed
03
Surgical resection (enucleation or partial pancreatectomy) for insulinoma when feasible
04
Medical management with diazoxide, octreotide, or everolimus in unresectable disease, post-bariatric, or NIPHS patients
05
Dietary modification with frequent low-glycemic meals and acarbose for post-bariatric hypoglycemia and long-term endocrine follow-up

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.