Have you ever experienced sudden dizziness, lightheadedness, and palpitations, exactly like when your blood sugar drops? Sometimes you think these things are just because you're hungry, but rarely, there can be another reason for this. Today, we're going to talk about a rare but important condition to be aware of. That's a condition called insulinoma.
What is this insulinoma?
Simply put, an insulinoma is a small, non-cancerous tumor that develops in our pancreas. Now you may be wondering what this pancreas is. The pancreas is a small but very important organ located inside our abdomen, behind the stomach. It produces enzymes that help us digest the food we eat, as well as a hormone called insulin, which controls our blood sugar levels.
So, when this insulinoma develops, it causes more insulin to be released into our blood than it should. It's like a clogged water tap that keeps leaking.
These insulinomas are a type of neuroendocrine tumor that develops in the pancreas called Pancreatic Neuroendocrine Tumors (pNETs). These are relatively rare tumors. The best part is that 85% to 90% of these insulinomas are nonmetastatic/indolent. This means that they do not spread to other parts of the body outside the pancreas. However, very rarely, they can become metastatic/aggressive. If they do, they are most likely to spread to nearby lymph nodes and the liver.
How does an insulinoma affect the body?
I mentioned earlier that an insulinoma is a tumor that produces too much insulin. So, what happens when there is too much insulin? The main function of insulin is to take the sugar (we also call it glucose) in the blood into the cells. Then the cells get energy. But when there is too much insulin, the amount of sugar in the blood suddenly decreases. We call this condition hypoglycemia . In Sinhala, it means a decrease in blood sugar.
When your blood sugar drops like this, you start to experience symptoms.
Imagine, you've eaten breakfast, gone to the office, and are working. Suddenly, you feel achy, sweaty, dizzy, and lightheaded. It's like you're tired and hungry.
At times like this, if you quickly eat or drink something sweet, like some apple juice, a cup of tea with sugar, or a banana, you'll start to feel better after a while.
But, having low blood sugar like this, especially without knowing the cause and not knowing when it will happen again, is really scary. So, it's a good idea to always keep a small snack, like a toffee, nearby. Also, if you have had this experience, you should see a doctor as soon as possible and tell them about it.
What are the symptoms of this?
The main symptom of insulinoma is, as mentioned earlier, low blood sugar (hypoglycemia). This can cause a variety of symptoms.
Common symptoms:
These are the first symptoms you may notice:
- Confusion or difficulty concentrating: As if your head is spinning, you can't concentrate on what you're doing.
- Sweating: Just sweating, maybe a cold sweat.
- Heart palpitations: You feel like you can hear your heart beating.
- Anxiety or irritability: Just a nervous state, easily angered.
- Tremors: Feels like your limbs are shaking.
- Feeling very hungry.
Serious symptoms:
If your blood sugar level drops too low, the condition can become more serious. You may experience symptoms like:
- Vision changes: Vision becomes blurry, like seeing two things at once.
- Speech difficulties: slurring of words, inability to speak clearly.
- Loss of balance or coordination: Staggering when walking, swaying back and forth when reaching for something.
- Seizures: Can come on like a fit.
- Loss of consciousness: You may faint and fall.
Most often, people with insulinoma experience this low blood sugar in the morning, that is, after waking up after a few hours of fasting after dinner. We call this ``fasting hypoglycemia''. However, some people can experience this low blood sugar even shortly after eating.
This is very important: Continuously low blood sugar levels can interfere with your daily activities, and can sometimes lead to brain damage, coma, and even death. So, if you have symptoms of low blood sugar, be sure to see a doctor.
Why does this insulinoma develop?
In fact, researchers still haven't figured out exactly why the insulin-producing cells in the pancreas suddenly divide and multiply uncontrollably, forming this tumor.
But one thing has been discovered. That is, this condition called insulinoma can sometimes come with a hereditary disease called ``Multiple Endocrine Neoplasia type 1`` or ``(MEN1)`` . In this, tumors form in several of the glands that produce hormones in our body (for example, the pituitary gland, parathyroid gland, pancreas). Not all ``(Insulinoma)`` are caused by ``(MEN1)``, but this ``(MEN1)`` condition can affect between 5% and 10% of all insulinoma patients.
If your family members, such as your mother, father, or siblings, have been told by doctors that they have the condition (MEN1), you should talk to your doctor about genetic testing . This can help you find out if you have the condition. If you have (MEN1), these tests can also help identify these tumors before they develop.
How do doctors detect this?
When you go to a doctor, they will ask you about your symptoms and examine you. There are three main signs that suggest you have an insulinoma. We call these the Whipple's triad .
They are:
1. Having symptoms of low blood sugar (like dizziness and sweating, as mentioned earlier)
2. A test that confirms that the blood sugar level is low. (Usually, a finger prick test shows a blood sugar level of less than 55 mg/dL)
3. Symptoms improve when you eat or drink something containing sugar (carbohydrates).
If you have all three of these symptoms, your doctor may suspect an insulinoma. He or she will then order a few more tests to confirm the diagnosis.
72-hour fast test
This is the main, "gold-standard" test for insulinoma. It requires you to fast for up to 72 hours. But don't worry, this is done in a hospital, under the supervision of a doctor or nurse. You are not alone.
When you fast like this, your blood sugar levels drop and you start experiencing symptoms, doctors will take a blood sample from you and test for the following:
- Blood sugar level
- Insulin level
- Proinsulin level
- C-peptide level
- Beta-hydroxybutyrate level
- Sulfonylurea level (this is used to check for the presence of certain medications used to treat diabetes in the blood)
After taking the blood, doctors will treat your low blood sugar. The results of these tests can help determine whether your low blood sugar is due to too much insulin (we call this hyperinsulinemia).
What other tests are done? (Imaging tests)
If the 72-hour fasting test suggests an insulinoma, the next step is to determine where the tumor is in the pancreas and how large it is. This may involve one or more of the following scans:
- CT scan
- MRI scan
- Abdominal ultrasound scan
- Endoscopic ultrasound (EUS): This involves inserting a tube with a small camera through the mouth and looking into the pancreas.
If these scans can't pinpoint the exact location of the tumor, your doctor may order another specialized test called a selective arterial calcium stimulation test. This is a more complicated test.
What is the treatment for this?
The good news is that most insulinomas can be completely cured with surgery, especially if the tumor has not spread to other areas (nonmetastatic).
The main thing is the surgery.
There are several types of surgery. Your doctor will decide which surgery is right for you based on the type, location, and size of your tumor.
- Enucleation: This involves removing only the tumor without causing significant damage to the pancreas, much like carefully removing only the yolk from a boiled egg.
- Partial pancreatectomy: As the name suggests, this involves cutting out and removing part of the pancreas where the tumor is located.
- Whipple surgery: This is a major surgery. It is done when the tumor has spread (metastatic). It involves removing part of the pancreas and some nearby tissue.
Every surgery has some risks. Your doctor will explain them all to you.
How to control low blood sugar before surgery and if surgery is not possible?
Until surgery, or if surgery is not possible for some reason, it is very important to control your low blood sugar.
- Check your blood sugar levels regularly: Your doctor may recommend that you use a Continuous Glucose Monitoring (CGM) system . This can help you monitor your blood sugar levels continuously. This can help you detect low blood sugar levels early, especially at night.
But remember, this ``(CGM)`` is not used to detect conditions like insulinoma, but to monitor the disease once it has been confirmed.
- Dietary changes: Eating foods at regular times, especially complex carbohydrates (e.g., whole-grain bread, brown rice, vegetables), can help prevent sudden drops in blood sugar. Eating a small snack before bed can also help some people.
- Intravenous glucose (IV glucose): If you have severe low blood sugar, you may be given glucose through saline in the hospital.
- Types of medicines:
- Diazoxide: This medication can control the release of insulin from the pancreas. It can also increase the release of glucagon (which increases blood sugar levels) from the liver.
- Octreotide and Lanreotide: These medications also help reduce the release of insulin from some insulinomas.
It's very important to always carry a medical identification card that says you have a low blood sugar condition. That way, if you suddenly have trouble, someone can help you quickly. Also, let your family and friends know about this and how they can help.
What to do if the tumor has spread (metastatic)?
Very rarely, if the insulinoma has spread to other parts of the body (metastatic), doctors may combine surgery with other treatments. Or, if surgery is not possible, this medical treatment may be used.
- Peptide Receptor Radionuclide Therapy (PRRT)
- Targeted therapy
- Chemotherapy
These are somewhat complex treatments, which your doctor will explain to you.
Can this be cured?
Yes! Insulinoma can often be completely cured with surgery. One study showed that 87% of people who had surgery for nonmetastatic insulinoma were still alive 10 years after diagnosis. That's a really good rate.
However, if the tumor has spread (metastatic), the 10-year survival rate is said to be about 33%. But remember, these are just general estimates. Depending on your situation, your medical team can give you more accurate information.
It's true that the word "tumor" can scare us. Especially when it's a rare condition like insulinoma. But the best part is that most of these can be treated with surgery. Even so, it's not easy to find out that you have a rare condition that requires surgery. But you're not alone. Your medical team will always be there for you, answering your questions, and supporting you. If you're feeling overwhelmed emotionally, talk to your doctor about that too and find out about the services you can get help from.
The most important things for you to remember (Take-Home Message)
Okay, so, from what we've talked about today, these are the most important things you need to remember:
- An insulinoma is a benign (mostly benign) tumor that develops in the pancreas. It produces too much insulin.
- This can cause a sudden drop in blood sugar (hypoglycemia). This can cause symptoms such as dizziness, sweating, and palpitations.
- If you experience these symptoms frequently, be sure to see a doctor.
- This can be detected through special tests (72-hour fasting test, scans).
- The main treatment is surgery. In most cases, this results in a complete cure.
- Before surgery, or if surgery is not possible, you can control low blood sugar levels through diet and medication.
- Although this is a rare condition, good outcomes can be achieved if recognized early and treated properly.
Don't worry, like any other illness, there is a treatment for this. The most important thing is to pay attention to the symptoms and seek medical advice as soon as possible.
` Insulinoma, pancreas, insulin, low blood sugar, hypoglycemia, tumor, hormone, pancreatic cancer
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