Background: Hyperinsulinaemic hypoglycaemia (HH) is characterized by the dysregulated secretion of insulin from the pancreatic β-cell. It is a major cause of severe and persistent hypoglycaemia in the newborn period. The rapid diagnosis and avoidance of recurrent episodes of hypoglycaemia are vital in preventing brain damage.
Objective and hypotheses: To assess if the serum insulin measured at the time of hypoglycaemia in neonates with HH could be correlated with the severity of the disease or any of the other biochemical parameters.
Method: Retrospectively biochemical data was collected on 90 neonates (gestational age 3242 weeks and birth weight 25.6 kg) with a diagnosis of HH based on (glucose requirement <8 mg/kg per min, low β-hydroxybutyrate and fatty acid concentrations) who had undergone fasting studies. Also, other parameters like birth weight and gestational age were compared to the serum insulin level at the time of hypoglycaemia.
Results: There was no correlation between the serum insulin level and severity of hypoglycaemia and some of the patients have undetectable serum insulin despite severe hypoglycaemia and a high glucose infusion rate. Also we observed a greater effect of insulin on ketogenesis than on the lipolysis. We noticed no correlation between birth weight and the serum insulin or glucose level at the time of hypoglycaemia or on the glucose infusion rate.
Conclusion: We have shown in a large cohort study that the diagnosis of HH should not be based on an isolated serum insulin concentration but on clinical findings (glucose requirement <8 mg/kg per min) and the biochemical of insulin action (low β-hydroxy butyrate and fatty acid concentration).
20 - 22 Sep 2014
European Society for Paediatric Endocrinology