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Dr. Andrew Rynne

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Can insulinoma cause low insulin levels?

Answered by
Dr.
Dr. Manjunath Metri

General Surgeon

Practicing since :2005

Answered : 383 Questions

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Posted on Thu, 26 Apr 2018 in Medicines and Side Effects
Question: i am waiting to read your dx, but am having technical difficulties i paid, then downloaded the app, but when i sign in it says i am not authenticated. PayPal transaction completed, so i hope you can email me your response! want to know what you think! do i have an insulinoma, lupus, or something else like a vitamin deficiency!
doctor
Answered by Dr. Manjunath Metri 2 hours later
Brief Answer:
Yes please ask your question completely..

Detailed Answer:
Hi and welcome to HealthcareMagic..
I thank you for posting your query here and I am definitely going to help you out..

Please note...

1. Please ask your question..
I will he happy to help you..

2. As far as I can understand, you have insulinoma..
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Manjunath Metri 2 days later
I am not sure that I have insulinoma, but that was one supposed idea...if so, wouldn't my c- something be high instead of low, also my insulin level was a bit low...these results do not make sense! if i truly had a high a1c, why are my glucose tests all normal to low? if the low glucose is explained by insulinoma, how could my insulin be low?. i think the blood lady switched my vial with someone else. Occam's razor.

recap...normal -1c of 5.3 in XXXXXXX but oct 30th reading was10.3 with insulin at 1.9 and the c-something at 0.71, blood glucose all below 125 after eating, fasting between 74 and 89. my doc said i do not have type 1 like she thought and took my insulin pen ( that i never used) back, and said i might have insulinoma. this seems to not fit... is there any logical explanation to these lab results??

original complaint was fatigue, just as an off hand comment at a physical. i have a relative with lupus and i work in a chemistry lab where i have been around some heavy metals ( Ni, Hg, Pb) and small amounts of methanol. i have arthritis in ankles hips knees and elbows. i have had a few days of blurry vision, but i recently got new lenses, so i am not sure if this is a true symptom or just a difficult transition to new prescription and frames...are my bifocals too high on the frame?? or are my eyes having issues?
i have seen an X shaped rash across my nose once that i know of and two occasions where odd comments were made to me ( wipe that off your face it looks ridiculous...oh, you don't have anything on your face and go wash with cold water) that makes me think others may have seen it on me as well... and a XXXXXXX undefined rash on my thigh twice. i think this rash could be lupus, but it is very transitory on me. some docs say the lupus rash is permanent, but i do not believe that as my aunt in law never had a visible rash that i saw, but definitely had lupus.
doctor
Answered by Dr. Manjunath Metri 1 hour later
Brief Answer:
Explained answers below

Detailed Answer:
Hi and welcome back..

Please note..
Answer to the first part of your question..

A. Yes.. Insulinoma classically presents with Whipples traid. And blood sugar levels may go to as low as 45mg!

So even I feel you are not suffering from Insulinoma.

B. You can get the CECT Abdomen and Pelvis. This will accurately clear all our doubts.
This scan will tell us how your pancreas is and if there is any kind of insulinoma or no.

C. If you are having doubts on blood reports, I suggest you to repeat the sugar levels in a different laboratory.

Now..
Second part of your question..

A. It's always better you visit an ophthalmologist and get your refractive tests done and then know whether you need change in glasses or no.

B. Do not worry about Lupus.
If you are so worried, I suggest you visit a Dermatologist or Physician and show those lesions and get yourself confirmed. Rather than worrying.

Hope this helps you..
In case you need further assistance, please contact me directly..
Or, you can close the question and rate.
Take care.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Manjunath Metri 46 hours later
I do not think i can go to another lab for my blood test, but i I'll inquire. most doctors seem to have agreements with a particular lab, but perhaps they will write me a 'script and let me go lab shopping...but i wouldn't know what to look for!

i do not worry about lupus, but am curious as to whether or not it could be contributing factor in the confusing blood test results.

i cannot repeat ac for three months...insurance will not approve until then, if it weren't too costly i might pay out of pocket, but i wouldn't want to pay more than say $10, and i bet it costs more than that!

what is the CECT?? is this a cat scan or MRI!??

c-peptide, is made when your body makes insulin... so this would be high if i had insulinoma?, but that one blood test showed up low... what is whip pleas triad.??

isn't it possible the high a1c is due to longer lived rbc's due to low carb diet?? with the low glucose numbers i just don't see how it would be insulinoma...what am i missing...i thought insulinoma meant you make too much insulin to the point of dangerously low blood glucose where you might have sweating and faintness etc... i do not have those symptoms.
doctor
Answered by Dr. Manjunath Metri 6 hours later
Brief Answer:
All your queries have been answered..

Detailed Answer:
Hi and welcome back..
I thank you for getting back with your doubts...

Please note..

1. The repeat tests were advised based on your doubts. It's not compulsory.
It was for you to confirm once again.
If you cannot do it then do not worry..

2. CECT is CONTRAST ENHANCED CT SCAN.
This will tell us the lesions in the Pancreas if any.

3. Yes C peptide would generally be on a higher side if you had Insulinoma.

4. Whipples traid is Classical clinical features when we see a case of Insulinoma.
A. Blood glucose less than 45
B. Symptoms of Hypoglycemia
C. When glucose is administered, patients become normal.

5. No...
High HbA1c indicates, bad control of sugars over long time duration.

6. Yes what you are thinking is correct..
Insulinoma presents this way.

Hence I have advised for CECT Abdomen and Pelvis.

Hope this helps you..
In case you need further assistance, please contact me back.
Or, you can close the question and rate..
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Manjunath Metri 36 hours later
just a quick update, appt was cancelled since my sugar levels are good. doc did order a sedimentation rate test, i guess this tests for inflammation, but i am not aware of any diagnosis that can be made from it. I will have to wait until April to see the only endocrinologist in my area, unless there is a cancellation before then. do you think i should try to see an endocrinologist in a larger town that is an hour and a half drive from me? is it safe to wait until April?

for the record...

you believe i do not have insulinoma because i have low c peptide and low insulin... if that was truly my blood result... because if i did have it i would have high insulin and high c peptide.

my low blood sugar is apparently normal, and since i do not have faintness or sweats i am okay.

i am not in a position to take a CECT to prove i do not have insulinoma...if my blood results prove i do not have it, i am not going to spend my deductible proving i don't have it. i am confused but you seem to take it as worry. i am not worried at all, but i do not comprehend how a blood test can go from 5.3 to a 10.1 in 4 months... and then have results of blood tests that prove i do not have high blood sugar...at all. i still say the simplest explanation is that the 10.1 a1c was not my blood. but i have no proof of that.

do you know of a logical explanation for how a patient would nearly double their a1c score in just 4 months?

what can my doc learn from sed rate blood test?
doctor
Answered by Dr. Manjunath Metri 3 hours later
Brief Answer:
Explained all your questions

Detailed Answer:
Hi and thanks for getting back...
Please note..

1. You can do both. Safely travel for 2 hours or wait till April if you do not have symptoms.

From my side, even if you are having insulinoma, you can wait, since it's a benign disease.
Just that you'll have hypoglycemic attacks.

2. It's quite possible..
We have seen so many such cases where we see gross differences in the blood reports.
Causes are
A. Uncontrolled sugars
B. Laboratory differences
C. Progression of the disease.

Now under what category you fall, it's difficult to say..

3. And regarding going for a CECT scan, you have to take the call.

4. Doctors rely on the reports. Because, it's the evidence that we have.
And most doctors do evidence based practice.

Hope this helps you..
In case you need further assistance, please contact me back.
Or you can close the question and rate.
Take care..
Above answer was peer-reviewed by : Dr. Raju A.T
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