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April 18, 2004

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Question from Windlesham, Surrey, England:

My ten year old son was diagnosed with hyperinsulinemia last October. He had been unwell for two years with low weight, palpitations, chest pain, excessive sweating, fatigue and bone cysts. Recent tests show his sugars are rising and the consultant says he is now insulin resistant. She states that she does not know why this condition has arisen. She expects him to gain weight suddenly and she will want to do biopsies to determine how the insulin receptors are functioning when a weight gain occurs. His insulin levels were six or seven times too high, but they have improved to only three or four times too high with diet. He is not on any medication at this time and there have not been any investigations of the pancreas. His continued fatigue and symptoms have made full time school an impossibility for the last year. Should we be pursuing medication or further investigations rather than this "wait and see" approach?

Answer:

If his insulin levels are so high, he should be evaluated soon by a pediatric endocrinologist and not just a pediatrician. It sounds like he would need special pancreas testing and perhaps a pancreatic biopsy to make sure that there is not a tumor or something called nesidioblastosis. There are medications that can be used for such diagnoses but, sometimes, surgery is needed. There are excellent pediatric endocrinologists in most large cities in the United Kingdom and at most large medical schools who have such experience.

SB