Table 4
Drugs used in the medical management of hyperinsulinism
| Drug | Diazoxide |
| Indication | Hyperinsulinaemic hypoglycaemia |
| Mechanism of action | Opens KATP channels, increases adrenaline (epinephrine) secretion, increases gluconeogenesis |
| Dose | 5–20 mg/kg/day orally 8 hourly |
| Side effects | Fluid retention (chlorothiazide + diazoxide used together), hypertrichosis, hyperuricaemia, facial changes, hypotension, rarely leucopenia, thrombocytopenia |
| Drug | Chlorothiazide (act synergistically with diazoxide by activating non-KATPchannels) |
| Dose | 7–10 mg/kg/day in 2 divided doses |
| Side effects | Hyponatraemia, hypokalaemia |
| Drug | Nifedipine (slow release preparation) |
| Indication | Hyperinsulinaemic hypoglycaemia |
| Mechanism of action | Calcium channel antagonist, inhibits insulin release |
| Dose | 0.25–2.5mg/kg/day orally 8 hourly |
| Response rate | Limited experience |
| Side effects | Hypotension |
| Drug | Glucagon |
| Mechanism of action | Increased glycogenolysis/gluconeogenesis |
| Dose | 1–10 μg/kg/hour intravenous infusion, 1 mg bolus dose intramuscular or intravenous |
| Side effects | Nausea, vomiting, increases growth hormone concentrations, increases myocardial contractility, decreases gastric acid/pancreatic enzymes |
| Drug | Octreotide |
| Indication | Hyperinsulinaemic hypoglycaemia |
| Mechanism of action | Activates G protein coupled rectifier K channel, hence inhibiting insulin release |
| Dose | 5–20 μg/kg/day intravenous or subcutaneous infusion |
| Side effects | Suppression of growth hormone, TSH, ACTH. Steatorrhea, cholelithiasis, abdominal distension, decreases growth rate |
-
ACTH, adrenocorticotrophin; KATP, ATP sensitive potassium channel; TSH, thyroid stimulating hormone.
