{"id":24711,"date":"2026-02-28T22:54:22","date_gmt":"2026-03-01T02:54:22","guid":{"rendered":"https:\/\/cliniqueomicron.ca\/insuline-a-jeun\/"},"modified":"2026-03-15T18:57:13","modified_gmt":"2026-03-15T22:57:13","slug":"fasting-insulin","status":"publish","type":"page","link":"https:\/\/cliniqueomicron.ca\/en\/insuline-a-jeun\/","title":{"rendered":"Fasting Insulin: Dosage, Interpretation, and Insulin Resistance | Clinique Omicron"},"content":{"rendered":"
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\n\t\t\t\t\t\n\n\n\n\nInsuline \u00e0 jeun : dosage, interpr\u00e9tation et r\u00e9sistance \u00e0 l'insuline | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"L'insuline \u00e0 jeun \u00e9value la s\u00e9cr\u00e9tion basale d'insuline et d\u00e9piste la r\u00e9sistance \u00e0 l'insuline. HOMA-IR, SOPK, syndrome m\u00e9tabolique, hyperinsulinisme et interpr\u00e9tation au Qu\u00e9bec.\">\n<meta name=\"keywords\" content=\"insuline \u00e0 jeun dosage, insuline \u00e0 jeun normale, HOMA-IR r\u00e9sistance insuline, hyperinsulinisme \u00e0 jeun, insuline \u00e0 jeun SOPK, insuline \u00e0 jeun syndrome m\u00e9tabolique, insuline basale dosage, r\u00e9sistance insuline Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap*{font-family:'Poppins',sans-serif;box-sizing:border-box}\n.co-wrap{max-width:1100px;margin:0 auto;padding:30px 0 60px}\n.co-label{font-family:'Cinzel',serif;font-size:14px;font-weight:bold;letter-spacing:1px;text-transform:uppercase;color:#4D6577;margin-bottom:14px;display:block}\n.co-wrap h1{font-size:32px;font-weight:500;color:#323C52;margin:0 0 22px;line-height:1.2}\n.co-intro{font-size:16px;line-height:1.75;color:#4D6577;margin-bottom:36px;padding-bottom:32px;border-bottom:1px solid rgba(77,101,119,.2)}\n.co-wrap h2{font-size:20px;font-weight:600;color:#323C52;margin:32px 0 12px}\n.co-wrap p{font-size:15px;color:#4D6577;line-height:1.7;margin-bottom:14px}\n.co-list{list-style:none;padding:0;margin:12px 0 24px}\n.co-list li{font-size:15px;color:#4D6577;padding:10px 14px 10px 38px;margin-bottom:8px;border-radius:6px;position:relative;background:rgba(77,101,119,.06);border-left:3px solid #4D6577}\n.co-list li::before{content:\"\u2713\";position:absolute;left:12px;font-weight:700;color:#4D6577}\n.co-table{width:100%;border-collapse:collapse;margin:14px 0 22px;font-size:14px;border-radius:8px;overflow:hidden;table-layout:fixed}\n.co-table thead tr{background:#323C52;color:#fff}\n.co-table thead th{padding:11px 16px;text-align:left;font-weight:600;font-size:13px}\n.co-table tbody tr:nth-child(even){background:rgba(77,101,119,.06)}\n.co-table tbody tr:nth-child(odd){background:#fff}\n.co-table td{padding:10px 16px;color:#4D6577;border-bottom:1px solid rgba(77,101,119,.12);font-size:14px;vertical-align:top}\n.co-table td:first-child{font-weight:600;color:#323C52}\n.co-infobox{display:flex;gap:12px;background:rgba(77,101,119,.06);border-radius:8px;border-left:4px solid #4D6577;padding:14px 18px;margin:18px 0 28px;font-size:14px;color:#4D6577;line-height:1.65}\n.co-infobox .ico{font-size:18px;flex-shrink:0}\n.co-urgence{background:#fff8f8;border-left:5px solid #c0392b;border-radius:6px;padding:20px 26px;margin:24px 0 32px}\n.co-urgence .co-urgence-titre{font-size:13px;font-weight:700;color:#c0392b;letter-spacing:1.5px;text-transform:uppercase;margin-bottom:10px}\n.co-urgence p{color:#5a2020;font-size:14px;margin:0 0 10px;line-height:1.7}\n.co-urgence p:last-child{margin-bottom:0}\n.co-disclaimer{font-size:13px;color:#8a9aaa;font-style:italic;border-top:1px solid rgba(77,101,119,.15);padding-top:24px;margin-top:40px;line-height:1.6}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Endocrinologie & Diab\u00e9tologie & M\u00e9decine interne & M\u00e9decine de famille<\/span>\n <h1>Insuline \u00e0 jeun<\/h1>\n\n <div class=\"co-intro\">\n L'insuline \u00e0 jeun est le dosage de la concentration s\u00e9rique d'insuline apr\u00e8s un je\u00fbne standardis\u00e9 d'au moins 8 heures, refl\u00e9tant la s\u00e9cr\u00e9tion basale des cellules b\u00eata du pancr\u00e9as en l'absence de stimulation alimentaire. Contrairement \u00e0 l'insuline postprandiale ou \u00e0 l'insuline mesur\u00e9e lors d'une charge glucos\u00e9e, l'insuline \u00e0 jeun renseigne sp\u00e9cifiquement sur le niveau de s\u00e9cr\u00e9tion autonome d'insuline n\u00e9cessaire \u00e0 la r\u00e9gulation de la glyc\u00e9mie basale et \u00e0 la suppression de la production h\u00e9patique de glucose endog\u00e8ne. Sa principale utilit\u00e9 clinique en m\u00e9decine de premi\u00e8re ligne est l'\u00e9valuation de la r\u00e9sistance \u00e0 l'insuline par le calcul de l'index HOMA-IR (Homeostasis Model Assessment \u2014 Insulin Resistance), qui combine l'insuline \u00e0 jeun et la glyc\u00e9mie \u00e0 jeun dans un mod\u00e8le math\u00e9matique valid\u00e9. Un r\u00e9sultat d'insuline \u00e0 jeun \u00e9lev\u00e9e \u2014 avec une glyc\u00e9mie \u00e0 jeun normale ou l\u00e9g\u00e8rement \u00e9lev\u00e9e \u2014 signe un hyperinsulinisme compensatoire caract\u00e9ristique de la r\u00e9sistance \u00e0 l'insuline, pr\u00e9sente dans le syndrome m\u00e9tabolique, le syndrome des ovaires polykystiques (SOPK) et les \u00e9tats pr\u00e9-diab\u00e9tiques. \u00c0 l'oppos\u00e9, une insuline \u00e0 jeun basse s'observe dans le diab\u00e8te de type 1 (destruction auto-immune des cellules b\u00eata) et dans certaines formes avanc\u00e9es de diab\u00e8te de type 2 (\u00e9puisement des cellules b\u00eata). Il est essentiel de rappeler que l'insuline \u00e0 jeun pr\u00e9sente des limites importantes : grande variabilit\u00e9 interindividuelle et intra-individuelle, interf\u00e9rence par les anticorps anti-insuline (chez les patients d\u00e9j\u00e0 sous insuline exog\u00e8ne), et absence de standardisation universelle entre les m\u00e9thodes de dosage \u2014 raison pour laquelle l'HOMA-IR est mieux interpr\u00e9t\u00e9 avec les normes du laboratoire et de l'\u00e9tude de r\u00e9f\u00e9rence utilis\u00e9e.\n <\/div>\n\n <h2>Physiologie, valeurs de r\u00e9f\u00e9rence et calcul de l'HOMA-IR<\/h2>\n <ul class=\"co-list\">\n <li><strong>S\u00e9cr\u00e9tion basale d'insuline et signification de l'insuline \u00e0 jeun :<\/strong> en condition de je\u00fbne (8h minimum \u2014 id\u00e9alement 10\u201312h) : la glyc\u00e9mie basale est maintenue dans la plage normale (3,9\u20135,5 mmol\/L) \u2192 par la s\u00e9cr\u00e9tion basale d'insuline \u2192 qui inhibe la production h\u00e9patique de glucose (glycog\u00e9nolyse + n\u00e9oglucogen\u00e8se) \u2192 et maintient l'\u00e9quilibre de la lipolyse \u2192 la s\u00e9cr\u00e9tion basale d'insuline repr\u00e9sente 40\u201350 % de la s\u00e9cr\u00e9tion totale d'insuline des 24h (le reste = r\u00e9ponse prandiale) \u2192 en situation de r\u00e9sistance \u00e0 l'insuline : les cellules cibles (foie + muscle + tissu adipeux) r\u00e9pondent moins bien \u00e0 l'insuline \u2192 les cellules b\u00eata compensent en augmentant leur s\u00e9cr\u00e9tion d'insuline \u2192 hyperinsulinisme compensatoire \u2192 maintien de la glyc\u00e9mie dans des limites normales ou l\u00e9g\u00e8rement \u00e9lev\u00e9es \u2192 \u00e0 mesure que la r\u00e9sistance s'aggrave \u2192 les cellules b\u00eata s'\u00e9puisent \u2192 l'insuline \u00e0 jeun diminue \u2192 la glyc\u00e9mie \u00e0 jeun augmente \u2192 DT2 \u2192 la courbe \u00ab bell-shape \u00bb de l'insulin\u00e9mie : dans la progression vers le DT2 : insuline \u00e0 jeun d'abord \u00e9lev\u00e9e (r\u00e9sistance compens\u00e9e) \u2192 puis diminue progressivement (\u00e9puisement des cellules b\u00eata) \u2192 phase finale : insuline basse + hyperglyc\u00e9mie franche = DT2 \u00e9tabli \u2192 cette dynamique explique pourquoi l'insuline \u00e0 jeun ne doit pas \u00eatre interpr\u00e9t\u00e9e seule, mais toujours avec la glyc\u00e9mie simultan\u00e9e et l'HbA1c ; valeurs de r\u00e9f\u00e9rence de l'insuline \u00e0 jeun : les valeurs normales varient significativement selon les m\u00e9thodes de dosage (immunoenzym\u00e9tiques vs immunochimioluminescentes) et les kits utilis\u00e9s \u2192 les normes de chaque laboratoire doivent \u00eatre utilis\u00e9es \u2192 valeurs indicatives g\u00e9n\u00e9ralement accept\u00e9es : insuline \u00e0 jeun normale : 2\u201325 \u00b5UI\/mL (14\u2013174 pmol\/L) selon les laboratoires \u2192 les valeurs >25 \u00b5UI\/mL chez un individu avec glyc\u00e9mie normale \u2192 \u00e9vocateur d'hyperinsulinisme compensatoire (r\u00e9sistance \u00e0 l'insuline) \u2192 les valeurs <2 \u00b5UI\/mL en pr\u00e9sence d'hyperglyc\u00e9mie \u2192 \u00e9vocateur d'insuffisance des cellules b\u00eata (DT1 ou DT2 avanc\u00e9) \u2192 les valeurs tr\u00e8s \u00e9lev\u00e9es (>100\u20131 000 \u00b5UI\/mL) en pr\u00e9sence d'hypoglyc\u00e9mie \u2192 \u00e9vocateur d'insulinome ou d'injection d'insuline exog\u00e8ne (diff\u00e9rencier par le peptide C) ; HOMA-IR (Homeostasis Model Assessment \u2014 Insulin Resistance) : formule valid\u00e9e par Matthews 1985 \u2014 Diabetologia \u2192 HOMA-IR = insuline \u00e0 jeun (\u00b5UI\/mL) \u00d7 glyc\u00e9mie \u00e0 jeun (mmol\/L) \/ 22,5 \u2192 ou si glyc\u00e9mie en mg\/dL : HOMA-IR = insuline \u00e0 jeun (\u00b5UI\/mL) \u00d7 glyc\u00e9mie \u00e0 jeun (mg\/dL) \/ 405 \u2192 interpr\u00e9tation : HOMA-IR <1,0 \u2192 sensibilit\u00e9 \u00e0 l'insuline normale (excellente) \u2192 HOMA-IR 1,0\u20131,9 \u2192 limite \u2192 HOMA-IR \u22652,0 \u2192 r\u00e9sistance \u00e0 l'insuline l\u00e9g\u00e8re \u2192 HOMA-IR \u22652,5 \u2192 r\u00e9sistance mod\u00e9r\u00e9e \u2192 HOMA-IR \u22655,0 \u2192 r\u00e9sistance s\u00e9v\u00e8re \u2192 les seuils varient selon les populations \u00e9tudi\u00e9es (ethnies + \u00e2ge + BMI) \u2192 certaines \u00e9tudes utilisent un seuil de 2,0 pour les Caucasiens + 1,8 pour les Asiatiques \u2192 HOMA-IR corr\u00e8le avec le clamp euglyc\u00e9mique hyperinsulin\u00e9mique (De Fronzo 1979 \u2014 American Journal of Physiology) \u2014 m\u00e9thode de r\u00e9f\u00e9rence (gold standard) mais invasive et r\u00e9serv\u00e9e \u00e0 la recherche \u2192 exemple clinique : patient avec glyc\u00e9mie \u00e0 jeun = 5,5 mmol\/L + insuline \u00e0 jeun = 18 \u00b5UI\/mL \u2192 HOMA-IR = 18 \u00d7 5,5 \/ 22,5 = 4,4 \u2192 r\u00e9sistance \u00e0 l'insuline mod\u00e9r\u00e9e \u00e0 s\u00e9v\u00e8re \u2192 recommandation : traitement du mode de vie (alimentation + exercice + perte de poids)<\/li>\n <li><strong>Conditions pr\u00e9alables au dosage et limites de l'insuline \u00e0 jeun :<\/strong> ESSENTIAL prerequisites for reliable dosing: strict fasting \u22658h (preferably 10-12h) \u2192 do not perform in a patient who has recently taken exogenous insulin \u2192 some drugs influence fasting insulin: drugs that increase fasting insulin: sulfonylureas (glibenclamide + gliclazide) \u2192 directly stimulate beta-cell secretion \u2192 artificially elevated insulinemia \u2192 meglitinides (repaglinide + nateglinide) \u2192 same effects \u2192 anabolic steroids + androgens \u2192 increase IGF-1 \u2192 potentiate insulin signaling \u2192 corticoids: increase insulin resistance \u2192 fasting insulin may be elevated + drugs decreasing fasting insulin: metformin (reduces hepatic glucose production \u2192 decreases insulin requirement \u2192 slightly reduced fasting insulin) \u2192 GLP-1 agonists + SGLT2i \u2192 reduce basal insulin secretion by reducing blood glucose + analytical interferences : endogenous anti-insulin antibodies (in patients treated with old bovine or porcine insulin - very rare) + autoimmune anti-insulin antibodies (insulin autoimmune syndrome - rare - Hirata) \u2192 very high false results + intra-individual variability: fasting insulin may vary by 30-50 % from one day to the next in the same patient \u2192 a single assay may be insufficient \u2192 average 2 to 3 measurements for better accuracy \u2192 in a research context \u2192 HOMA-IR calculated on the average of 3 consecutive fasting samples + limitations of HOMA-IR: only assesses liver insulin resistance (hepatic glucose production) \u2192 does not reflect muscle resistance (euglycemic clamp assesses both) \u2192 not recommended as a universal screening tool in routine clinical practice \u2192 but useful in research + epidemiology + individualized follow-up of patients with metabolic syndrome or PCOS <\/ul>\n\n <h2>Interpr\u00e9tation clinique selon les r\u00e9sultats<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>R\u00e9sultat \/ contexte<\/th><th>Interpretation and course of action<\/th><th>References and recommendations<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Insuline \u00e0 jeun \u00e9lev\u00e9e + glyc\u00e9mie normale \u2014 r\u00e9sistance \u00e0 l'insuline<br><small style=\"font-weight:400;color:#7a8fa0;\">Syndrome m\u00e9tabolique \u2014 SOPK \u2014 ob\u00e9sit\u00e9 \u2014 pr\u00e9diab\u00e8te \u2014 acanthosis nigricans \u2014 HOMA-IR \u2014 traitement mode de vie \u2014 metformine \u2014 SGLT2i \u2014 GLP-1<\/small><\/td>\n <td>Insuline \u00e0 jeun \u00e9lev\u00e9e (>15\u201325 \u00b5UI\/mL) + glyc\u00e9mie \u00e0 jeun normale (3,9\u20135,5 mmol\/L) \u2192 hyperinsulinisme compensatoire \u2192 r\u00e9sistance \u00e0 l'insuline \u2192 HOMA-IR \u22652,5 \u2192 conduite \u00e0 tenir : confirmer par la glyc\u00e9mie \u00e0 jeun + HbA1c + bilan lipidique (triglyc\u00e9rides + HDL + LDL) + tour de taille \u2192 \u00e9valuation du syndrome m\u00e9tabolique (IDF 2005 : \u22653 crit\u00e8res sur 5 : TT \u00e9lev\u00e9 + TG \u22651,7 mmol\/L + HDL bas + glyc\u00e9mie \u00e0 jeun \u22655,6 mmol\/L + TA \u2265130\/85 mmHg) \u2192 si SOPK suspect\u00e9 (femme en \u00e2ge de procr\u00e9er + oligo-anovulation + hyperandrog\u00e9nisme) : dosage FSH + LH + testost\u00e9rone + \u00e9chographie ovarienne \u2192 HGPO 75g si pr\u00e9diab\u00e8te suspect\u00e9 \u2192 signes cliniques de r\u00e9sistance \u00e0 l'insuline : acanthosis nigricans (hyperpigmentation verruqueuse nuque + aisselles + aines \u2014 signe d'hyperinsulinisme s\u00e9v\u00e8re) + ob\u00e9sit\u00e9 abdominale (TT \u2265 94 cm homme \/ \u226580 cm femme) + acrochordons (molluscum pendulum \u2014 petites excroissances cutan\u00e9es dans les plis) + traitement : perte de poids (5\u201310 % du poids) : r\u00e9duction de la r\u00e9sistance \u00e0 l'insuline de 30\u201350 % \u2192 exercice physique r\u00e9gulier (150 min\/sem + r\u00e9sistance musculaire) : activation de la voie AMPK \u2192 augmentation de GLUT4 \u2192 am\u00e9lioration de la sensibilit\u00e9 musculaire + alimentation : r\u00e9duction des glucides raffin\u00e9s + des graisses satur\u00e9es \u2192 r\u00e9gime m\u00e9diterran\u00e9en ou DASH \u2192 metformine : r\u00e9duction de la production h\u00e9patique de glucose + am\u00e9lioration de la sensibilit\u00e9 p\u00e9riph\u00e9rique \u2192 indiqu\u00e9e si pr\u00e9diab\u00e8te + facteurs de risque \u00e9lev\u00e9s (Diabetes Canada 2023 + ADA 2024) + SGLT2i + GLP-1 agonistes (s\u00e9maglutide) : donn\u00e9es croissantes dans la r\u00e9sistance \u00e0 l'insuline + SOPK \u2192 r\u00e9duction du poids + am\u00e9lioration de la sensibilit\u00e9 \u00e0 l'insuline + surveillance : glyc\u00e9mie \u00e0 jeun + HbA1c tous les 6\u201312 mois si r\u00e9sistance document\u00e9e \u2192 d\u00e9pistage du DT2<\/td>\n <td>Matthews 1985 \u2014 Diabetologia : HOMA-IR \u2192 validation + interpr\u00e9tation \u2192 r\u00e9f\u00e9rence internationale + De Fronzo 1979 \u2014 American Journal of Physiology : clamp euglyc\u00e9mique \u2192 gold standard r\u00e9sistance \u00e0 l'insuline \u2192 + Yildiz 2003 \u2014 NEJM : SOPK + r\u00e9sistance \u00e0 l'insuline + hyperandrog\u00e9nisme \u2192 m\u00e9canismes + IDF 2005 : syndrome m\u00e9tabolique \u2192 crit\u00e8res + pr\u00e9valence + ADA 2024 Standards of Diabetes Care : r\u00e9sistance \u00e0 l'insuline + pr\u00e9diab\u00e8te + metformine + Diabetes Canada 2023 : guidelines \u2192 r\u00e9sistance \u00e0 l'insuline + pr\u00e9diab\u00e8te + metformine + INESSS Qu\u00e9bec : programmes de pr\u00e9vention du DT2 + d\u00e9pistage + Estruch 2013 \u2014 NEJM (PREDIMED) : r\u00e9gime m\u00e9diterran\u00e9en + syndrome m\u00e9tabolique \u2192 r\u00e9duction des MACE de 30 % <\/tr>\n <tr>\n <td>Insuline \u00e0 jeun basse + hyperglyc\u00e9mie \u2014 insuffisance des cellules b\u00eata<br><small style=\"font-weight:400;color:#7a8fa0;\">DT1 \u2014 DT2 avanc\u00e9 \u2014 LADA \u2014 insulinop\u00e9nie \u2014 auto-anticorps \u2014 peptide C \u2014 HbA1c \u2014 insulinoth\u00e9rapie \u2014 classification diab\u00e8te<\/small><\/td>\n <td>Insuline \u00e0 jeun basse (<5 \u00b5UI\/mL) + hyperglyc\u00e9mie \u00e0 jeun (>7,0 mmol\/L) \u2192 insuffisance de la s\u00e9cr\u00e9tion des cellules b\u00eata \u2192 insulinop\u00e9nie \u2192 orientation diagnostique : DT1 : destruction auto-immune des cellules b\u00eata \u2192 anti-GAD65 + anti-IA-2 + anti-ZnT8 + anti-insuline positifs \u2192 peptide C ind\u00e9tectable ou tr\u00e8s bas (<0,2 ng\/mL) \u2192 d\u00e9but souvent brutal + c\u00e9tose ou acidoc\u00e9tose \u2192 traitement : insulinoth\u00e9rapie obligatoire + DT2 avanc\u00e9 (\u00e9puisement des cellules b\u00eata apr\u00e8s des ann\u00e9es de r\u00e9sistance et d'hyperglyc\u00e9mie chronique) : auto-anticorps n\u00e9gatifs + peptide C encore pr\u00e9sent mais bas (0,2\u20130,5 ng\/mL) + \u00e9volution progressive sur des ann\u00e9es + traitement : si peptide C r\u00e9siduel \u2192 insuline basale en addition aux antidiab\u00e9tiques oraux \u2192 si peptide C quasi nul \u2192 sch\u00e9ma basal-bolus + LADA (Latent Autoimmune Diabetes in Adults) : diab\u00e8te d'aspect initial DT2 (pas d'acido-c\u00e9tose) mais auto-anticorps positifs (anti-GAD65 en particulier) + insuline \u00e0 jeun progressivement basse + peptide C qui d\u00e9cline \u2192 initialement trait\u00e9 comme un DT2 puis n\u00e9cessite l'insuline \u2192 Tuomi 1993 \u2014 Diabetologia : description du LADA \u2192 contexte clinique : l'insuline \u00e0 jeun seule ne suffit pas \u00e0 distinguer les types de diab\u00e8te \u2192 toujours combiner avec : peptide C stimul\u00e9 + auto-anticorps + HbA1c + contexte clinique + MODY (d\u00e9ficit monog\u00e9nique) : insuline \u00e0 jeun normale ou l\u00e9g\u00e8rement basse selon le g\u00e8ne mut\u00e9 \u2192 auto-anticorps n\u00e9gatifs + glyc\u00e9mie l\u00e9g\u00e8rement ou mod\u00e9r\u00e9ment \u00e9lev\u00e9e + ATCD familiaux multig\u00e9n\u00e9rationnels \u2192 g\u00e9notypage requis<\/td>\n <td>Tuomi 1993 \u2014 Diabetologia : LADA \u2192 description et crit\u00e8res + Greenbaum 2021 \u2014 NEJM : teplizumab + DT1 \u2192 pr\u00e9servation du peptide C \u2192 ADA 2024 + ISPAD 2022 : classification du diab\u00e8te + auto-anticorps + peptide C + Diabetes Canada 2023 : classification + traitement du diab\u00e8te \u2192 LADA + DT1 + DT2 + MODY + INESSS + RAMQ Qu\u00e9bec : couverture insulinoth\u00e9rapie + analogues selon le type de diab\u00e8te <\/tr>\n <tr>\n <td>Insuline \u00e0 jeun tr\u00e8s \u00e9lev\u00e9e + hypoglyc\u00e9mie \u2014 insulinome et hyperinsulinisme<br><small style=\"font-weight:400;color:#7a8fa0;\">Insulinome \u2014 hypoglyc\u00e9mie \u00e0 jeun \u2014 peptide C \u00e9lev\u00e9 \u2014 je\u00fbne 72h \u2014 ratio insuline\/glucose \u2014 NEM-1 \u2014 hypoglyc\u00e9mie factice \u2014 sulfonylur\u00e9es \u2014 diagnostic diff\u00e9rentiel<\/small><\/td>\n <td>Insuline \u00e0 jeun tr\u00e8s \u00e9lev\u00e9e (>18 \u00b5UI\/mL selon Endocrine Society 2009) + glyc\u00e9mie <3,0 mmol\/L + peptide C \u00e9lev\u00e9 \u2192 hyperinsulinisme endog\u00e8ne \u2192 insulinome en premier lieu \u2192 algorithme diagnostique : v\u00e9rifier la triade de Whipple (sympt\u00f4mes + glyc\u00e9mie basse + r\u00e9solution \u00e0 la correction glyc\u00e9mique) \u2192 mesure simultan\u00e9e : insuline + peptide C + pro-insuline + glyc\u00e9mie \u2192 b\u00e9ta-hydroxybutyrate (bas si insuline \u00e9lev\u00e9e \u2014 l'insuline inhibe la lipolyse + la c\u00e9togen\u00e8se) \u2192 si hypoglyc\u00e9mie non reproductible spontan\u00e9ment \u2192 je\u00fbne prolong\u00e9 supervis\u00e9 de 72h \u2192 r\u00e9sultats lors d'une hypoglyc\u00e9mie document\u00e9e : insuline >3 \u00b5UI\/mL + peptide C >0,2 nmol\/L + pro-insuline >5 pmol\/L \u2192 hyperinsulinisme endog\u00e8ne \u2192 insulinome (90 % b\u00e9nin) \u2192 diff\u00e9rentiel : sulfonylur\u00e9e ou m\u00e9glitinide \u2192 peptide C \u00e9lev\u00e9 mais sulfonylur\u00e9e d\u00e9tect\u00e9e dans les urines \u2192 injection d'insuline exog\u00e8ne (hypoglyc\u00e9mie factice) \u2192 insuline \u00e9lev\u00e9e + peptide C BAS ou ind\u00e9tectable (car l'insuline exog\u00e8ne ne contient pas de peptide C) \u2192 localisation de l'insulinome : IRM abdominale + \u00e9cho-endoscopie pancr\u00e9atique (70\u201390 % de sensibilit\u00e9) + TEP au Ga-68 DOTATATE \u2192 traitement : r\u00e9section chirurgicale \u2192 gu\u00e9rison dans 90 % des b\u00e9nins \u2192 diazoxide en pr\u00e9-op\u00e9ratoire ou si inop\u00e9rable (inhibe la s\u00e9cr\u00e9tion des cellules b\u00eata par ouverture des canaux K\u207a-ATP) \u2192 octr\u00e9otide si r\u00e9cepteurs SSTR2\/SSTR5 pr\u00e9sents \u2192 voir aussi la fiche Insuline \/ Peptide C pour l'algorithme complet + ratio insuline\/glucose de Turner : insuline \u00e0 jeun (\u00b5UI\/mL) \/ glyc\u00e9mie \u00e0 jeun (mg\/dL) \u00d7 100 \u2192 si >30 \u2192 suspect d'hyperinsulinisme endog\u00e8ne \u2192 m\u00e9thode ancienne mais encore cit\u00e9e<\/td>\n <td>Cryer 2009 \u2014 Journal of Clinical Endocrinology and Metabolism (Endocrine Society Guidelines on Hypoglycemia) : seuils diagnostiques pour l'hyperinsulinisme endog\u00e8ne lors d'une hypoglyc\u00e9mie \u2192 r\u00e9f\u00e9rence absolue + Service 1999 \u2014 NEJM : insulinome \u2192 diagnostic + algorithme + Grant 2020 \u2014 JCEM : je\u00fbne 72h + crit\u00e8res actualis\u00e9s + Kaplan 1986 \u2014 NEJM : calcium intra-art\u00e9riel + localisation insulinome + Endocrine Society 2014 + AACE : guidelines insulinome + hyperinsulinisme + Diabetes Canada 2023 + ADA 2024 : hypoglyc\u00e9mie chez le non-diab\u00e9tique \u2192 algorithme diagnostique + INESSS Qu\u00e9bec : acc\u00e8s aux tests diagnostiques (dosage insuline + peptide C + je\u00fbne 72h en milieu sp\u00e9cialis\u00e9) <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span><strong>L'insuline \u00e0 jeun doit TOUJOURS \u00eatre interpr\u00e9t\u00e9e avec la glyc\u00e9mie \u00e0 jeun simultan\u00e9e \u2014 jamais isol\u00e9ment :<\/strong> A high fasting insulin with normal blood glucose indicates insulin resistance (calculate HOMA-IR). A low fasting insulin with hyperglycemia indicates beta-cell insufficiency. A very high fasting insulin with hypoglycemia necessitates ruling out an insulinoma or surreptitious sulfonylurea use (differentiated from factitious causes by C-peptide, which is high in case of insulinoma and undetectable in case of exogenous insulin injection).<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations requiring urgent medical attention<\/div>\n <p><strong>Insuline \u00e0 jeun tr\u00e8s \u00e9lev\u00e9e (>50 \u00b5UI\/mL) + hypoglyc\u00e9mie document\u00e9e (<3,0 mmol\/L) + peptide C \u00e9lev\u00e9 + en dehors de tout traitement par sulfonylur\u00e9e ou insuline<\/strong> \u2192 endogenous hyperinsulinism (probable insulinoma) \u2192 urgent endocrinology consultation \u2192 72-hour fast if hypoglycemia is not reproducible \u2192 abdominal MRI + pancreatic echoendoscopy \u2192 resection surgery \u2192 diazoxide while awaiting.<\/p>\n <p><strong>Insuline \u00e0 jeun \u00e9lev\u00e9e + glyc\u00e9mie normale ou l\u00e9g\u00e8rement \u00e9lev\u00e9e + jeune femme avec oligom\u00e9norrh\u00e9e + hyperandrog\u00e9nisme + HOMA-IR >3,0<\/strong> Severe insulin resistance in the context of PCOS \u2192 endocrinology + gynecology consultation \u2192 combined treatment: weight loss + exercise + metformin + or semaglutide + combined oral contraceptive if hyperandrogenism \u2192 fertility assessment if desire for pregnancy.<\/p>\n <p><strong>Hypoglyc\u00e9mie + insuline tr\u00e8s \u00e9lev\u00e9e + peptide C ind\u00e9tectable + patient sous insuline th\u00e9rapeutique \u2014 ou suspicion de prise clandestine d'insuline chez un patient non diab\u00e9tique<\/strong> \u2192 Factitious hypoglycemia due to exogenous insulin injection \u2192 Urgent psychiatric and medical consultation \u2192 Screen for sulfonylurea and exogenous insulin (anti-insulin antibodies) \u2192 No insulinoma if undetectable C-peptide.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins de Clinique Omicron prescrivent et interpr\u00e8tent l'insuline \u00e0 jeun dans le cadre du bilan du syndrome m\u00e9tabolique, de la r\u00e9sistance \u00e0 l'insuline, du SOPK et de l'\u00e9valuation du pr\u00e9diab\u00e8te. Ils calculent le HOMA-IR, initient les modifications du mode de vie et la metformine si indiqu\u00e9e, et orientent vers l'endocrinologue pour les hypoglyc\u00e9mies organiques et les hyperinsulinismes pathologiques. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin ou d'un endocrinologue. L'insuline \u00e0 jeun doit toujours \u00eatre interpr\u00e9t\u00e9e en contexte clinique complet, avec la glyc\u00e9mie simultan\u00e9e, le peptide C et les m\u00e9dicaments du patient.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Insuline \u00e0 jeun : dosage, interpr\u00e9tation et r\u00e9sistance \u00e0 l’insuline | Clinique Omicron Endocrinologie & Diab\u00e9tologie & M\u00e9decine interne & M\u00e9decine de famille Insuline \u00e0 jeun L’insuline \u00e0 jeun est le dosage de la concentration s\u00e9rique d’insuline apr\u00e8s un je\u00fbne standardis\u00e9 d’au moins 8 heures, refl\u00e9tant la s\u00e9cr\u00e9tion basale des cellules b\u00eata du pancr\u00e9as en… <a href=\"https:\/\/cliniqueomicron.ca\/en\/insuline-a-jeun\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Fasting Insulin: Dosage, Interpretation, and Insulin Resistance | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Insuline \u00e0 jeun : dosage, | Brossard | Clinique Omicron","_metasync_otto_description":"L'insuline \u00e0 jeun \u00e9value la s\u00e9cr\u00e9tion basale d'insuline et d\u00e9piste la r\u00e9sistance \u00e0 l'insuline. HOMA-IR, SOPK, syndrome m\u00e9tabolique, hyperinsulinisme et inter...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Insuline \u00e0 jeun : dosage, | Brossard | Clinique Omicron","_metasync_otto_og_description":"L'insuline \u00e0 jeun \u00e9value la s\u00e9cr\u00e9tion basale d'insuline et d\u00e9piste la r\u00e9sistance \u00e0 l'insuline. HOMA-IR, SOPK, syndrome m\u00e9tabolique, hyperinsulinisme et inter...","_metasync_otto_twitter_title":"Insuline \u00e0 jeun : dosage, | Brossard | Clinique Omicron","_metasync_otto_twitter_description":"L'insuline \u00e0 jeun \u00e9value la s\u00e9cr\u00e9tion basale d'insuline et d\u00e9piste la r\u00e9sistance \u00e0 l'insuline. HOMA-IR, SOPK, syndrome m\u00e9tabolique, hyperinsulinisme et inter...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Insuline \u00e0 jeun : dosage, interpr\u00e9tation et r\u00e9sistance \u00e0 l'insuline | Clinique Omicron","_aioseo_description":"L'insuline \u00e0 jeun \u00e9value la s\u00e9cr\u00e9tion basale d'insuline et d\u00e9piste la r\u00e9sistance \u00e0 l'insuline. 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