Table 4

Drugs used in the medical management of hyperinsulinism

Drug Diazoxide
IndicationHyperinsulinaemic hypoglycaemia
Mechanism of actionOpens KATP channels, increases adrenaline (epinephrine) secretion, increases gluconeogenesis
Dose5–20 mg/kg/day orally 8 hourly
Side effectsFluid retention (chlorothiazide + diazoxide used together), hypertrichosis, hyperuricaemia, facial changes, hypotension, rarely leucopenia, thrombocytopenia
Drug Chlorothiazide (act synergistically with diazoxide by activating non-KATPchannels)
Dose7–10 mg/kg/day in 2 divided doses
Side effectsHyponatraemia, hypokalaemia
Drug Nifedipine (slow release preparation)
IndicationHyperinsulinaemic hypoglycaemia
Mechanism of actionCalcium channel antagonist, inhibits insulin release
Dose0.25–2.5mg/kg/day orally 8 hourly
Response rateLimited experience
Side effectsHypotension
Drug Glucagon
Mechanism of actionIncreased glycogenolysis/gluconeogenesis
Dose1–10 μg/kg/hour intravenous infusion, 1 mg bolus dose intramuscular or intravenous
Side effectsNausea, vomiting, increases growth hormone concentrations, increases myocardial contractility, decreases gastric acid/pancreatic enzymes
Drug Octreotide
IndicationHyperinsulinaemic hypoglycaemia
Mechanism of actionActivates G protein coupled rectifier K channel, hence inhibiting insulin release
Dose5–20 μg/kg/day intravenous or subcutaneous infusion
Side effectsSuppression of growth hormone, TSH, ACTH. Steatorrhea, cholelithiasis, abdominal distension, decreases growth rate
  • ACTH, adrenocorticotrophin; KATP, ATP sensitive potassium channel; TSH, thyroid stimulating hormone.