Hypoglycaemia
Hypoglycaemia is a term for low blood sugars. The normal blood sugar range is 4-6 mmol/L. When blood sugar levels are less than 3.0 mmol/L (which is about 55 mg/dl in different units), the nerves in the brain do not work well. There is no clear cut off sugar level that determines hypoglycaemia. It is likely that every child has a certain 'threshold' below which the brain is affected. Most doctors would investigate and treat children if the sugar drops below a level of 3.0 mmol/L.
Read MoreMedical Management
The immediate priority of management of hypoglycaemia (low sugars) in the context of Congenital Hyperinsulinism (CHI), is to stabilise the sugar levels. Ideally, all sugars should be more than 3.5 mmol/l. To achieve this, your doctors may wish to put in a 'central line', which is a tube that goes into a big vein. Using a central line, strong solutions of sugar can be given safely.
Read MoreInvestigations: biochemistry, genetics
It is important that a correct diagnosis is made for the cause of hypoglycaemia (low blood sugars). Children who require a lot of sugar solutions to keep their sugars stable may have Congenital Hyperinsulinism (CHI). In normal children, low blood sugars will switch off the sugar lowering hormone insulin, which is made in the pancreas. In CHI, insulin is made constantly, whatever the level of blood sugar. As a result, children with CHI have severe and unpredictable hypoglycaemia.
Read More18-fluoro-Dopa-PET-CT scan
This is a special scan to find out if only one part of the pancreas is affected. This is called a focal lesion or focal Congenital Hyperinsulinism (CHI). Focal CHI can be treated by an operation to the part of the pancreas affected with CHI. The rest of the pancreas is left alone, which means that after focal surgery, the child is cured. The scan may show that the whole pancreas is equally affected; this is called diffuse CHI. For diffuse CHI, the best option is treatment with medicines. If medicines do not work, then surgery to remove most of the pancreas may have to be done.
Read MorePancreatic surgery
Broadly there are two types of surgery of the pancreas. In the condition called focal Congenital Hyperinsulinism (CHI), where only a small part of the pancreas is affected, surgery to the affected area can be done with complete cure. However, occasionally when the focal CHI is in a part of the pancreas which is close to important structures, surgery may not be the best thing to do. In particular, if the focal CHI is close to a bit of plumbing called the 'bile duct', it may be wise to defer surgery and treat with medicines.
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