blood analysis

hyperinsulinemia

Generality

There is talk of hyperinsulinemia whenever blood tests show an excess of insulin in the blood .

This condition, not necessarily pathological, is typical of people with type II diabetes mellitus and - more generally - of those who have developed a form of insulin resistance.

Furthermore, hyperinsulinemia is commonly associated with the metabolic syndrome.

Insulin

Let us briefly recall that insulin is a hormone of pancreatic origin, very important for regulating blood glucose levels (blood glucose). Insulin, in particular, facilitates the entry of glucose - a primary energy substrate - into insulin-dependent tissues (consisting largely of muscle and adipose tissue). At this level the cells exhibit particular receptors for insulin, which once linked to the hormone cause the translocation, from the cytoplasm to the plasma membrane, of special glucose transporters. In this way there is the passage of sugar from the blood to the interstitial liquid and finally to the cell, which uses it as an energy source.

Causes

Throughout life, due to congenital or acquired factors, it may happen that the cells become less sensitive to insulin; in these cases we speak of insulin resistance . Regardless of the numerous causes that can produce it (we refer to the article dedicated to those wishing to study the subject further), in the initial phases this condition causes hyperinsulinemia.

The pancreas, in fact, tries to compensate for the reduced cellular sensitivity by increasing the synthesis and release of the hormone. When this condition becomes chronic, the overwork of the pancreas and the negative effects of hyperinsulinemia itself on cellular sensitivity cause a functional decline of the cells used for insulin production and the appearance of fasting hyperglycemia; the compensatory mechanism described above is thus dropped and one can speak for all purposes of type II diabetes mellitus. It is not surprising, therefore, that hyperinsulinemia precedes in many cases - even a few years - the appearance of diabetes mellitus.

Very rarely, hyperinsulinemia can be caused by a tumor involving the cells responsible for the production of insulin ( insulinoma ), or by the presence of too many such cells (nesidioblastosi). Acute hyperinsulinemia (short-term and transient) may instead be the consequence of excessive intake of insulin or sugars.

Symptoms

In general, hyperinsulinemia does not cause particular signs and symptoms; when it is particularly accentuated it can however be associated with tremors, sweating, lethargy, fainting and coma, all symptoms due to the condition of reactive hypoglycemia that is created.

Complications

Considering the endocrine actions of the hormone, in the presence of hyperinsulinemia there is also an increased hepatic synthesis of triglycerides (hypertriglyceridemia); at the renal level, on the other hand, the increased sodium retention favors the appearance of hypertension. For all these reasons - and due to the frequent association with obesity, hyperandrogenism, fatty liver disease, dyslipidemia, smoking, hyperuricemia, polycystic ovary and atherosclerosis - hyperinsulinemia is considered an important and independent cardiovascular risk factor.

Treatment

The treatment of hyperinsulinemia obviously depends on the causes that determined it; if it involves a serious hypoglycemia, it will have to be treated through the intake of high and medium glycemic index sugars; in the most serious cases an intramuscular injection of glucagon or intravenous glucose is necessary. Insulinoma therapy is essentially surgical. When hyperinsulinemia is associated with insulin resistance, it can be effectively treated with the practice of regular exercise, proper diet and weight loss, possibly assisted by specific supplements (pectins and soluble fibers reduce the intestinal absorption of glucose, with flattening of the postprandial glycemic curve). When dietary and behavioral changes fail to bring the glycemic condition back to acceptable values, special hypoglycemic drugs can be used.