Yu dɔn ɛva gɛt diziz wantɛm wantɛm, yu ed kin layt, ɛn yu at kin bit, jɔs lɛk we yu blɔd shuga kin go dɔŋ? Sɔntɛnde yu kin tink se dɛn tin ya na jɔs bikɔs yu angri, bɔt nɔto ɔltɛm, ɔda rizin kin de fɔ dis. Tide, wi go tɔk bɔt wan rare bɔt impɔtant kɔndishɔn we wi fɔ no bɔt. Dat na wan sik we dɛn kɔl insulinoma.
Wetin na dis insulinoma?
Fɔ tɔk am simpul wan, insulinoma na smɔl tumbu we nɔ gɛt kansa ɛn we kin kam na wi pankrias. Naw yu kin de wɔnda wetin na dis pankrias. di pankrias na sכmכl bכt rili imכtant כgan we de insay wi bכdi, bihayn di bεlε. I de mek ɛnzaym dɛn we de ɛp wi fɔ dayjɛst di it we wi de it, ɛn i de mek wan ɔmon we dɛn kɔl insulin, we de kɔntrol di shuga we de na wi blɔd.
So, we dis insulinoma de divɛlɔp, i de mek mɔ insulin kɔmɔt na wi blɔd pas aw i fɔ kɔmɔt. I tan lɛk wata tap we dɔn lɔk we de kɔntinyu fɔ lik.
dis insulinoma dεm na wan kayn nyuroεndokrin tכmכro we de divεlכp na di pankrias we dεn kכl Pankreas Nyuroεndokrin Tכmכro (pNETs). Dis na tumbu dɛn we nɔ kin bɔku. di bεst pat na dat 85% to 90% pan dεn insulinoma dεm ya nכ de mεtastas/indolent. dis min se dεn nכ de spre to כda pat dεm na di bכdi we de ausayd di pankrias. Bɔt, na smɔl tɛm nɔmɔ, dɛn kin bi mɛtastas/agresiv. If dɛn du dat, i go mɔs bi se dɛn go spre to di limf no dɛm we de nia ɛn di liva.
Aw insulinoma kin afɛkt di bɔdi?
A bin dɔn tɔk se insulinoma na tumbu we de mek insulin tumɔs. So, wetin kin apin we insulin bɔku? di men wok we insulin de du na fכ tek di shuga (wi kכl am bak glukכs) we de insay di bכdi insay di sεl dεm. Dɔn di sɛl dɛn kin gɛt ɛnaji. Bɔt we insulin bɔku, di shuga we de na di blɔd kin go dɔŋ wantɛm wantɛm. Wi kin kɔl dis kɔndishɔn haypoglycemia . Insay Sinhala, i min se di blɔd shuga go dɔŋ.
We yu blɔd shuga drɔp lɛk dis, yu kin bigin fɔ gɛt sɔm sayn dɛn.
Imajin, yu dɔn it brɛf, go na ɔfis, ɛn yu de wok. Wantɛm wantɛm, yu kin fil pen, yu de swet, yu ed de tɔn, ɛn yu ed nɔ de shayn. I tan lɛk se yu taya ɛn angri.
Sɔntɛnde lɛk dis, if yu it ɔ drink sɔntin we swit kwik kwik wan, lɛk sɔm apul jus, wan kɔp ti wit shuga, ɔ banana, yu go bigin fɔ fil fayn afta sɔm tɛm.
Bɔt, fɔ gɛt lɔw blɔd shuga lɛk dis, mɔ we yu nɔ no di kɔz ɛn nɔ no ustɛm i go apin bak, kin rili mek yu fred. So, i fayn fɔ kip smɔl snek, lɛk tofi, nia yu ɔltɛm. Dɔn bak, if yu dɔn gɛt dis ɛkspiriɛns, yu fɔ go to dɔktɔ kwik kwik wan ɛn tɛl dɛn bɔt am.
Wetin na di sayn dɛm fɔ dis?
Di men sayn fɔ insulinoma na, lɛk aw wi bin dɔn tɔk, di blɔd shuga we de dɔŋ (hypoglycemia). Dis kin mek yu gɛt difrɛn kayn sayn dɛm.
Di sayn dɛn we kin apin:
Dis na de fɔs sayn wae yu kin notis:
- Kɔnfyushɔn ɔ prɔblɛm fɔ pe atɛnshɔn: I tan lɛk se yu ed de spin, yu nɔ go ebul fɔ pe atɛnshɔn pan wetin yu de du.
- Swet: Jɔs swet, sɔntɛm na kol swet.
- At de bit: Yu kin fil lɛk se yu kin yɛri yu at de bit.
- Wae yu de wɔri ɔr yu de vɛks: Na jɔs wan nervɔs stet, wae yu kin vɛks kwik kwik wan.
- Tremor: I kin fil lɛk se yu an ɛn fut dɛn de shek.
- Fɔ fil se i rili angri.
Siriɔs sayn dɛn we de sho se yu gɛt dis sik:
If yu blɔd shuga go dɔŋ tumɔs, di sik kin rili siriɔs. Yu kin gɛt sɔm kayn sik lɛk:
- Vishɔn kin chenj: Vishɔn kin bi blɔk, lɛk fɔ si tu tin wan tɛm.
- I nɔ kin izi fɔ tɔk: i nɔ kin tɔk fayn, i nɔ kin ebul fɔ tɔk klia wan.
- Lɔs fɔ balans ɔr kɔdineshɔn: I de stɛdi we yu de waka, yu de swɛla bak ɛn go bifo we yu de rich fɔ sɔntin.
- Seizures: I kin kam pan lɛk fit.
- Nɔr kin no natin: Yu kin fɔdɔm ɛn fɔdɔm.
Bɔrku tɛm, pipul dɛm wae gɛt insulinoma kin gɛt dis lɔw blɔd shuga na mɔnin, dat na afta dɛn wek afta sɔm awa dɔn fast afta dɛn dɔn it dina. Wi kin kɔl dis ``fastin haypoglycemia''. Bɔt sɔm pipul dɛn kin gɛt dis lɔw blɔd shuga ivin jɔs afta dɛn dɔn it.
Dis rili impɔtant: We yu kɔntinyu fɔ gɛt smɔl smɔl shuga na yu blɔd, dat kin mek yu nɔ ebul fɔ du tin dɛn we yu de du ɛvride, ɛn sɔntɛnde i kin mek yu bren pwɛl, yu kin kɔma, ɛn ivin day. So, if yu gɛt sayn dɛn we de sho se yu blɔd shuga nɔ bɔku, mek shɔ se yu go to dɔktɔ.
Wetin mek dis insulinoma kin kam?
Infakt, di wan dɛn we de stɔdi bɔt dis stil nɔ dɔn no di rayt tin we mek di sɛl dɛn we de mek insulin na di pankrias kin sheb wantɛm wantɛm ɛn bɔku we dɛn nɔ ebul fɔ kɔntrol, ɛn dɛn kin mek dis tɔŋ.
Bɔt dɛn dɔn fɛn wan tin. Dat min se sɔm tɛm dɛn kin kɔl dis sik we dɛn kɔl insulinoma Multiple Endocrine Neoplasia type 1, ɔ (MEN1).I kin gɛt fɔ du bak wit wan sik we pɔsin kin gɛt frɔm in mama ɛn papa we dɛn kɔl insulinoma. dis na we tכmכro de fכm insay sεvεra כmon-prodyuz gland dεm na wi bכdi (fכ egzampl, di pituitary gland, paratayroyd gland, pankrias). nכto כl insulinoma dεm na MEN1 de kכz am, bכt 5% to 10% pan כl insulinoma dεm na MEN1 de kכz am.
If dɔktɔ dɛn dɔn tɛl yu famili mɛmba dɛn lɛk yu mama, papa, ɔ brɔda ɛn sista dɛn se dɛn gɛt dis sik (MEN1), yu fɔ tɔk to yu dɔktɔ bɔt aw fɔ tɛst yu jɛnɛtiks . Dis kin ɛp yu fɔ no if yu gɛt dis sik. If yu gɛt (MEN1), dɛn tɛst ya kin ɛp bak fɔ no dɛn tumbu ya bifo dɛn bigin.
Aw dɔktɔ dɛn kin no dis?
We yu go to dɔktɔ, dɛn go aks yu bɔt yu sik dɛn ɛn chɛk yu. Tri men sayn dɛn de we de sho se yu gɛt insulinoma. Wi kɔl dɛn wan ya di triad we Whipple mek .
Dɛn na:
1. Fɔ gɛt sayn dɛn we de sho se yu blɔd shuga nɔ bɔku (lɛk we yu de tɔn diziz ɛn swet, lɛk aw wi bin dɔn tɔk) .
2. Test we de sho se di shuga na di blɔd nɔ bɔku. (Bɔku tɛm, we dɛn prɛk finga tɛst de sho se di blɔd shuga lɛvɛl nɔ rich 55 mg/dL)
3. Di sik kin bɛtɛ we yu it ɔ drink sɔntin we gɛt shuga (kabɔhaydrɛt).
If yu gɛt ɔl dɛn tri tin ya, yu dɔktɔ kin tink se yu gɛt insulinoma. Dɔn i go ɔda fɔ mek dɛn du sɔm ɔda tɛst dɛn fɔ mek dɛn no se i gɛt di sik.
72 awa fast tɛst
Dis na di men, "gold-standard" tεst fכ insulinoma. I nid fɔ mek yu fast fɔ te 72 awa. Bɔt nɔ wɔri, dɛn kin du dis na ɔspitul, ɔnda di sɔpɔtishɔn fɔ dɔktɔ ɔ nɔs. Nɔto yu wan de.
We yu fast lɛk dis, yu blɔd shuga lɛvɛl go dɔŋ ɛn yu bigin fɔ gɛt di sik, dɔktɔ dɛn go tek blɔd sɛmpul frɔm yu ɛn tɛst fɔ dɛn tin ya:
- Di blɔd shuga lɛvɛl
- Insulin lɛvɛl
- Di lɛvɛl we di proinsulin gɛt
- C-pεptida lεvεl
- Beta-haydroksibutyrate lεvεl
- Sulfonylurea level (dɛn kin yuse dis fɔ chɛk fɔ si if sɔm mɛrɛsin dɛn we dɛn kin yuz fɔ mɛn dayabitis de na di blɔd) .
Afta yu dɔn tek di blɔd, dɔktɔ dɛn go trit yu blɔd shuga we nɔ bɔku. Di rizulyt fɔ dɛn tɛst ya kin ɛp fɔ no if yu blɔd shuga we smɔl na bikɔs ɔf bɔku insulin (wi kin kɔl dis hyperinsulinemia).
Us ɔda tɛst dɛn dɛn kin du? (Tɛst dɛn we dɛn kin yuz fɔ mek pikchɔ dɛn)
If di tɛst we dɛn du fɔ fast fɔ 72 awa sho se yu gɛt insulinoma, di nɛks tin we yu fɔ du na fɔ no usay di tumbu de na di pankrias ɛn aw i big. Dis kin involv wan ɔ mɔ pan dɛn skan ya:
- CT skan we dɛn kin du
- MRI skan we dɛn kin du
- Abdominal ɔltra saund skan
- Endoscopic ultrasound (EUS): Insay dis, dɛn kin put wan tiub we gɛt smɔl kamɛra tru di mɔt ɛn go rayt te to di pankrias.
If dɛn skan ya nɔ ebul fɔ no usay di tumbu de, yu dɔktɔ kin ɔda fɔ du ɔda spɛshal tɛst we dɛn kɔl sɛlɛktiv atria kalsiɔm stimulashɔn tɛst. Dis na tɛst we rili kɔmplikt.
Wetin na di tritmɛnt fɔ dis?
di gud nyus na dat mכst insulinoma dεm kin kכmplit kכl wit כpεrayshכn, εspεshali if di tכmכro nכ spre to כda εria dεm (nonmetastatic).
Di men tin na di ɔpreshɔn.
Bɔku kayn ɔpreshɔn dɛn de. Yu dɔktɔ go disayd us ɔpreshɔn we fayn fɔ yu bay di kayn, usay yu gɛt, ɛn di sayz we yu gɛt.
- Enucleation: Dis involv fכ pul di tכmכro nכmכ we nכ de mek bכku damej pan di pankrias, jכs lεk fכ tek tεm pul di yכlk nכmכ frכm eg we dεn bכyl.
- Pat pan di pankrias: As di nem sho, dis involv fכ kכt εn pul pat pan di pankrias usay di tכmכro de.
- Wipɛl ɔpreshɔn: Dis na big ɔpreshɔn. dεn kin du am we di tכmכro dכn spre (mεtastatik). I min fɔ pul wan pat pan di pankrias ɛn sɔm tisu dɛn we de nia am.
Ɛni ɔpreshɔn kin gɛt sɔm prɔblɛm dɛn. Yu dɔktɔ go ɛksplen dɛn ɔl to yu.
Aw fɔ kɔntrol di blɔd shuga we nɔ de bɔku bifo dɛn du di ɔpreshɔn ɛn if ɔpreshɔn nɔ pɔsibul?
Te di ɔpreshɔn, ɔ if ɔpreshɔn nɔ pɔsibul fɔ sɔm rizin, i rili impɔtant fɔ kɔntrol di shuga we yu gɛt na yu blɔd.
- Chek yu blɔd shuga ɔltɛm: Yu dɔktɔ kin tɛl yu fɔ yuz wan Kɔntinyu Glucose Monitoring (CGM) sistem . Dis kin ɛp yu fɔ wach aw yu blɔd shuga de kɔntinyu fɔ de. Dis kin ɛp yu fɔ no if yu blɔd shuga nɔ bɔku kwik kwik wan, mɔ na nɛt.
Bɔt mɛmba se, dɛn nɔ kin yuz dis `(CGM)` fɔ no di kɔndishɔn lɛk insulinoma, bɔt fɔ wach di sik wans dɛn dɔn kɔnfyus am.
- Di chenj we yu de it: If yu it it ɔltɛm, mɔ di kɔmpleks kabɔhaydrɛt (e.g., ɔl-grɛn bred, brawn rays, vɛjitebul), i kin ɛp fɔ mek yu blɔd shuga nɔ go dɔŋ wantɛm wantɛm. If yu it smɔl snek bifo yu go slip, dat kin ɛp sɔm pipul dɛn bak.
- Intravenous glucose (IV glucose): If yu gɛt siriɔs lɔw blɔd shuga, dɛn kin gi yu glukɔs tru salin na ɔspitul.
- Di kayn mɛrɛsin dɛn we dɛn kin yuz:
- Dayazɔksayd: Dis mɛrɛsin kin kɔntrol di we aw insulin de kɔmɔt na di pankrias. I kin mek bak di glukagon (we de mek di blɔd shuga lɛvɛl go ɔp) kɔmɔt na di liva.
- Octreotide ɛn Lanreotide: Dɛn mɛrɛsin ya kin ɛp bak fɔ ridyus di insulin we de kɔmɔt frɔm sɔm insulinomas.
I rili impɔtant fɔ kɛr wan mɛdikal aydentifikeshɔn kad ɔltɛm we se yu gɛt lɔw blɔd shuga kɔndishɔn. Da we de, if yu gɛt prɔblɛm wantɛm wantɛm, sɔmbɔdi go ɛp yu kwik kwik wan. Dɔn bak, mek yu fambul ɛn padi dɛn no bɔt dis ɛn aw dɛn go ɛp.
Wetin fɔ du if di tumbu dɔn skata (mɛtastas)?
Na smɔl tɛm nɔmɔ, if di insulinoma dɔn skata to ɔda pat dɛn na di bɔdi (metastatic), dɔktɔ dɛn kin jɔyn ɔpreshɔn wit ɔda tritmɛnt dɛn. Ɔ, if i nɔ pɔsibul fɔ du ɔpreshɔn, dɛn kin yuz dis mɛrɛsin.
- Pɛptid Risɛptɔ Redionyuklayd Tɛrapi (PRRT) .
- Targeted therapy
- Kimotɛrapi
Dis na sɔm tritmɛnt dɛn we kɔmpleks, we yu dɔktɔ go ɛksplen to yu.
Yu tink se dɛn go ebul fɔ mɛn dis?
Yɛs! Bɔku tɛm, dɛn kin wɛl di insulinoma kpatakpata if dɛn du ɔpreshɔn pan am. Wan stכdi sho se 87% pan di pipul dεm we dεn bin du כpεrayshכn fכ nonmetastatic insulinoma bin stil de alayv 10 ia afta dεn no di sik. Dat na rili gud ret.
כltu, if di tכmכro dכn spre (mεtastatik), dεn se di 10 ia sכvayv rεt na bכt 33%. Bɔt mɛmba se dɛn tin ya na jɔs jɔnaral ɛstimat. Dipen pan yu situeshɔn, yu mɛdikal tim kin gi yu mɔ kɔrɛkt infɔmeshɔn.
Na tru se di wɔd "tumor" kin mek wi fred. Ɛspɛshali we na wan sik we nɔ kin apin lɛk insulinoma. Bɔt di bɛst tin na dat, dɛn kin trit bɔku pan dɛn tin ya wit ɔpreshɔn. Ivin so, i nɔ kin izi fɔ no se yu gɛt wan sik we nɔ kin apin so ɔltɛm we yu nid fɔ du ɔpreshɔn. Bɔt nɔto yu wan de. Yu mɛdikal tim go de fɔ yu ɔltɛm, ansa yu kwɛstyɔn dɛn, ɛn sɔpɔt yu. If yu de fil bad bad wan, tɔk to yu dɔktɔ bɔt dat bak ɛn no bɔt di savis dɛm wae yu kin gɛt ɛp frɔm.
Di tin dɛn we impɔtant pas ɔl fɔ mek yu mɛmba (Take-Home Message) .
Okay, so, dis na di impɔtant tin dɛn we yu nid fɔ mɛmba frɔm wetin wi dɔn tɔk bɔt tide:
- Insulinoma na benign (mɔstly benign) tכmכro we de divεlכp na di pankrias. I de mek bɔku insulin.
- Dis kin mek di blɔd shuga go dɔŋ wantɛm wantɛm (haypoglycemia). Dis kin mek yu gɛt sɔm sayn dɛm lɛk fɔ gɛt diziz, fɔ swet, ɛn fɔ mek yu at pwɛl.
- If yu kin gɛt dɛn sik ya ɔltɛm, mek shɔ se yu go to dɔktɔ.
- yu kin no dis tru spεshal tεst (72 awa fasting tεst, skan).
- Di men tritmɛnt na ɔpreshɔn. Bɔku tɛm, dis kin mek i wɛl ɔl.
- Bifo yu du ɔpreshɔn, ɔ if yu nɔ pɔsibul fɔ du ɔpreshɔn, yu kin kɔntrol di blɔd shuga we nɔ de bɔku tru it ɛn mɛrɛsin.
- Pan ɔl we dis nɔ kin apin so ɔltɛm, gud tin kin apin if dɛn no am kwik ɛn trit am fayn.
Nɔr wɔri, lɛk ɛni ɔda sik, tritmɛnt de fɔ dis. De tin wae impɔtant pas ɔl na fɔ pe atɛnshɔn to de sayn dɛm ɛn go to dɔktɔ kwik kwik wan.
` Insulinoma, pankrias, insulin, low blɔd shuga, haypoglycemia, tumor, ɔmon, pankrias kansa
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