Generality
We talk about hyperinsulinemia whenever blood chemistry 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.
Insulin
We recall briefly that insulin is a hormone of pancreatic origin, very important for regulating blood glucose levels (glycaemia). Insulin, in particular, facilitates the entry of glucose - an energy substrate of primary importance - into the tissues. insulin-dependent (consisting largely of muscle and adipose tissue). At this level the cells expose particular receptors for insulin, which once bound to the hormone cause the translocation, from the cytoplasm to the plasma membrane, of special transporters of the glucose In this way, sugar is passed from the blood to the interstitial fluid and finally to the cell, which uses it as a source of energy.
Causes
In the course of life, due to congenital or acquired factors, it can happen that the cells become less sensitive to insulin; in these cases, we speak of insulin resistance. deepen the topic), in the initial stages 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. the production of insulin and the appearance of fasting hyperglycemia; the compensatory mechanism described above is thus eliminated and one can speak to all intents and purposes of type II diabetes mellitus. It is therefore not surprising that hyperinsulinemia precedes the onset of diabetes mellitus in many cases - even by a few years.
Very rarely, hyperinsulinemia can be caused by a tumor involving insulin-producing cells (insulinoma), or by the presence of an excessive number of these cells (nesidioblastosis). An acute (short-term and transient) hyperinsulinemia it can instead be the consequence of an "excessive intake of insulin or sugars.
Symptoms
In general, hyperinsulinemia does not cause particular signs and symptoms; when it is particularly pronounced it can however be associated with tremors, sweating, lethargy, fainting and coma, all symptoms due to the reactive hypoglycemic condition 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 onset of hypertension. For all these reasons - and for the frequent association with obesity, hyperandrogenism, hepatic steatosis, dyslipidemia, smoking, hyperuricemia, polycystic ovary and atherosclerosis - hyperinsulinemia it 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 severe hypoglycemia, it will be treated through the intake of sugars with a high and medium glycemic index; in the most severe cases an intramuscular injection of glucagon or intravenous glucose is required. Insulinoma therapy is essentially surgical. When hyperinsulinemia is associated with insulin resistance, it can be effectively treated with the practice of regular exercise, appropriate diet and weight loss, possibly assisted by specific supplements (pectin and soluble fiber reduce intestinal absorption of glucose, with a flattening of the postprandial glycemic curve.
