hiperinsulinemia

Hyperinsulinemia is a condition characterized by higher-than-normal circulating insulin. It most often occurs with insulin resistance, where tissues respond poorly to insulin and the pancreas increases secretion to maintain glucose balance. It can also result from autonomous insulin secretion by pancreatic beta cells or from external insulin or secretagogues.

Common endogenous causes include obesity-related insulin resistance, metabolic syndrome, and polycystic ovary syndrome. Less often, insulin-secreting tumors (insulinomas) or nesidioblastosis cause unregulated insulin release. Exogenous hyperinsulinemia may follow therapeutic insulin, sulfonylurea use, or other secretagogues. Congenital hyperinsulinism occurs in infancy and childhood due to genetic defects.

Hyperinsulinemia may be asymptomatic and found incidentally. It can contribute to hypoglycemia, especially during fasting or prolonged exercise. Evaluation typically includes fasting insulin and glucose with C-peptide and, if needed, proinsulin to distinguish endogenous from exogenous sources. Additional testing like an oral glucose tolerance test or supervised fasts assesses insulin response.

Management targets the underlying cause and insulin resistance when present. Lifestyle changes such as weight loss and physical activity are central; metformin or other insulin-sensitizing agents may be used in appropriate cases. If a tumor or nesidioblastosis is present, surgical or targeted therapies are considered. Prognosis depends on the etiology; persistent hyperinsulinemia associated with insulin resistance increases long-term risk of type 2 diabetes and cardiovascular disease if not addressed.