There’s more to diabetes

Just Humalog and semi long acting Lantus. Maker lies because it only works 12 hours at best. Normal dose of Humalog is not the lousy sliding scale doctors tell patients to use but one unit per Kg of body weight. Eli Lilly’s circular says so. I just took eighty units of Humalog to combat 420 carbs. Refer to blood sugar chart for more info.

It is puzzling why an endocrinologist would not have immediately pursued the standard evaluation for fasting hypoglycemia, namely a 48-72 hour fast measuring insulin, c-peptide, proinsulin, cortisol, and a sulfonylurea screen when and only when she develops hypoglycemia.

She seems to meet the criteria of whipples triad (a low blood glucose level, symptoms of neuroglycopenia, and reversal of these symptoms after ingestion of carbohydrate). There should be no shock at finding a “normal” insulin or c-peptide level given that these were not drawn at the the correct time namely keeping the company of a blood glucose less than 50.

Likewise the “normal” abdominal CT scan is of limited value before an accurate biochemical diagnosis has been reached. Many insulinomas are too small to see on CT, and calcium stimulated selective venous sampling or intraoperative ultrasound is needed. However it is not appropriate to image prior to a properly conducted biochemical evaluation.

That should be the next step.

One Comment

    anna

    Thanks for this insight. I will recommend it to my friends. Take care.

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