Congenital Hyperinsulinism In Adults

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[full Text] Managing Congenital Hyperinsulinism: Improving Outcomes With A Multidi | Rred

Division of Endocrinology and Diabetes, The Childrens Hospital of Philadelphia, Philadelphia, PA, USA Abstract: Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in pediatric patients and is associated with significant risk of hypoglycemic seizures and developmental delays. CHI results from mutations in at least nine genes that play a role in regulating beta-cell insulin secretion. Thus, patients with CHI have dysregulated insulin secretion that is unresponsive to blood glucose level. Each different genetic etiology of CHI is associated with particular clinical characteristics that affect management decisions. Given the broad phenotypic spectrum and relatively rare prevalence of CHI, it is important that patients with CHI be evaluated by clinicians experienced with CHI and the multiple subspecialty services that are necessary for the management of the disorder. In this review, we summarize the pathophysiology and genetic causes of CHI and then focus primarily on the most common genetic cause (mutations in the ATP-gated potassium [KATP] channel) for further discussion of diagnosis, medical and surgical management, and potential acute and chronic c Continue reading >>

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  1. Liang-Hai Sie

    Personally, I've haven't taken any breakfast (other than when vacationing) since I started med school. Am now 4 years into retirement.
    Knowing what we now know it might not have been the most healthy choice, at that time in the sixties we didn't know better.
    These effects have now been described:
    In children it induces insulin resistance, which is one of the hallmarks of future type 2 diabetes see Regular Breakfast Consumption and Type 2 Diabetes Risk Markers in 9- to 10-Year-Old Children in the Child Heart and Health Study in England (CHASE): A Cross-Sectional Analysis and a discussion on this paper on the NHS pages Missing breakfast linked to type 2 diabetes
    In adult type 2 diabetics it correlates with higher blood sugar levels after lunch and dinner and an impaired insulin response to food Fasting Until Noon Triggers Increased Postprandial Hyperglycemia and Impaired Insulin Response After Lunch and Dinner in Individuals With Type 2 Diabetes: A Randomized Clinical Trial a discussion on which you can read on Skipping breakfast with type 2 diabetes could cause dangerous spikes in blood glucose levels

    According to Prospective Study of Breakfast Eating and Incident Coronary Heart Disease in a Cohort of Male US Health Professionals skipping breakfast is correlated with a 27% higher risk of coronary heart disease, for a discussion on the matter see Page on www.nhs.uk

    So maybe you should have a little something in the morning.

  2. James Bennett

    Originally Answered: From a medical perspective, is skipping breakfast really that unhealthy?

    "First of all, we have the large scale epidemiological studies showing an association with breakfast skipping and higher body weights in the population. One researcher from that study, commenting on the association with breakfast skipping or food choices for breakfast, said:
    "These groups appear to represent people 'on the run,' eating only candy or soda, or grabbing a glass of milk or a piece of cheese. Their higher BMI would appear to
    support the notion that 'dysregulated' eating patterns are associated with obesity, instead of or in addition to total energy intake per se."
    Kellogg's and clueless RDs love to cite them over and over again, so people are lead to believe that breakfast has unique metabolic and health-related benefits. In reality, these studies just show breakfast eaters maintain better dietary habits overall.
    Other studies frequently cited claiming that breakfast is beneficial for insulin sensitivity are all marred with methodological flaws and largely uncontrolled in design.
    In one widely cited study, subjects were entrusted to eat most meals in free-living conditions. The breakfast skipping group ate more and gained weight, which affected health parameters negatively.
    From the abstract: "Reported energy intake was significantly lower in the EB period (P=0.001), and resting energy expenditure did not differ significantly between the 2 periods." EB = eating breakfast. In essence, people who ate breakfast could control their energy intake better for the rest of the day. They didn't gain any weight but the breakfast skipping group did. Fat gain always affects insulin sensitivity and other health parameters negatively. Thus what people took this to mean is that breakfast is healthy and improves insulin sensitivity. Which isn't at all what the study showed."

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