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March 18, 2003


Question from Chorley,Lancashire, England:

I have just moved in with my 18 year old best friend who had nesidioblastosis as a baby, consequently had 95% of her pancreas removed, and now she is insulin dependent. She has unstable blood sugars ranging 2-21.9 mmol/L [36-394 mg/dl], and doesn't eat regularly. I really want to help her without fussing, but I don't know how. I know you need to eat regular with normal diabetes, but hers is different. I don't know the difference in symptoms between a hypo and hyper, so I don't know how to help her with this. Could you explain a little more about this condition please?


Nesidioblastosis is a condition usually confined to childhood in which there is proliferation of the islet cells within the pancreas. Children who suffer from this condition have recurrent, severe hypoglycemia. In order to decrease the mass of insulin-secreting cells, a large part of the pancreas is surgically removed. This may leave the individual deficient of insulin later in life as conditions change. This would also mean taking exogenous insulin to replace what is deficient.

Because the administration of injectable insulin is very awkward and less efficient with delivery compared to normal insulin secretion, patients who take insulin have to balance the timing of their insulin, the dose of the insulin, and the amount of food they eat. Lack of attention to detail along these lines puts patients at risk of high, low, and rapidly changing blood sugars. Low blood sugars [hypoglycemia] are associated with symptoms which include nervousness, sweating, hunger, lightheadedness, palpitations, and a decrease in mental alertness. The change in mental status may even result in loss of consciousness and seizures. If patients lose consciousness, they can be treated with a medication called glucagon. You may want to talk to your friend about glucagon and how you could help in the event of a severe low blood sugar. High blood sugars [hyperglycemia] result in irritability, frequent urination, sluggishness, and loss of weight.