Pediatric hypoglycemia isn’t always easy to diagnose and manage. Many patients require input from multiple specialties, including endocrinology, radiology, genetics and surgery. For community and regional providers, these gaps can make it difficult to determine when escalation or a referral is needed.

Cincinnati Children’s recently launched a comprehensive Hypoglycemia Program to support patients who need coordinated subspecialty care. The program is the first of its kind in the Midwest, and one of only three in the country dedicated to caring for this patient population.

Mansa Krishnamurthy, MD, MSc, an endocrinologist, serves as the director of the program, which she developed in partnership with Juan Pablo Gurria, MD, MSc, a surgeon in the Division of Pediatric General and Thoracic Surgery, and Andrew Trout, MD, radiologist-in-chief for the Department of Radiology and Medical Imaging.

From Clinical Demand to Program Development

Krishnamurthy began seeing patients with hypoglycemia when she joined Cincinnati Children’s as a faculty member four years ago. At the time, the Midwest lacked specialists to treat this patient population, she says. For that reason, and through word of mouth, Krishnamurthy quickly grew her patient base.

While she could manage many patients with simple cases of hypoglycemia, Krishnamurthy soon learned that some patients with hypoglycemia require a dedicated team.

“As the volume and complexity increased, I realized we needed a multidisciplinary team to meet the needs of our patients,” she says. “We needed more resources to care for these patients. And we needed to standardize how we cared for them.”

Last summer, Krishnamurthy met with Amy Shah, MD, MS, the director of the Division of Diabetes and Endocrinology, to discuss a growth proposal to create a hypoglycemia program at Cincinnati Children’s. With the support of Daniel Ostlie, MD, surgeon-in-chief of surgical services, and the entire growth committee, the plan received the green light, and the program went live at the beginning of this year.

Coordinated, Multispecialty Care Across the Continuum

The Hypoglycemia Program is multidisciplinary, composed of team members from a variety of specialties, including endocrinology, surgery, radiology, pathology, genetics, psychology, feeding, and neonatal and pediatric critical care.

“Most of these patients are identified at birth, so our neonatology group is very important for ensuring they catch patients with low blood sugar and involve us early,” Krishnamurthy says.

For patients with hyperinsulinism, where medications aren’t working, surgery, radiology and pathology often come into play. The team may perform a PET scan to determine the type of disease, which helps inform the surgeon how much of the pancreas needs to be removed.

Because comorbidities are common in patients with hypoglycemia, neurodevelopmental specialists and psychologists step in as needed to perform testing and address conditions like seizure disorders or potential developmental delays. Members of the Cincinnati Children’s Interdisciplinary Feeding Team are available to provide evaluation and management for patients who experience feeding difficulties, and dietitians and nurses also play major roles.

In addition, the program allows patients and their parents to visit with their provider via telemedicine as an initial consult and after they return home from their inpatient and clinic visits.

“We can help parents and patients make changes to their medication dose or diet virtually,” Krishnamurthy says. “It’s something that makes us unique. We’re the only center in the Midwest, but we can also offer telemedicine visits to a very large catchment area, so patients have access to the team of providers when they need it.”

Bridging Clinical Care and Translational Research

As a physician-scientist, Krishnamurthy also conducts research focused on genetic forms of diabetes and congenital hyperinsulinism.

Because hyperinsulinism was only identified as a specific subset of hypoglycemia in the 1950s, less is known about the condition compared to other well-established endocrine disorders like diabetes, Krishnamurthy says.

“Hyperinsulinism is a rare and very heterogeneous disease, with different layers of severity,” she adds. “When you look at the genetics, up to 50% of patients don’t have a known genetic cause. That’s why one of the questions we ask is whether the genetic testing we do today is good enough to capture patients, and should we dig deeper?”

In her lab, Krishnamurthy is digging deeper, using whole-genome sequencing on blood and tissue samples, and examining various methylation changes to see whether they could be a cause of hyperinsulinism.

“There’s just no way someone is born with hyperinsulinism without there being an underlying genetic cause,” she says.

Krishnamurthy is also using disease modeling in her lab to better understand how genetic mutations might be causing anomalies in beta cell development, leading to excess insulin production and secretion. She combines patient-derived pancreatic organoids with genetic correction to study hyperinsulinism in the lab. In addition to studying pancreas development, these organoids can also be used to test new therapies to see whether they suppress insulin secretion before trying them in patients.

“In addition to genetic discovery, we also perform disease modeling to better understand hyperinsulinism, and we’re testing new therapies that are in the pipeline,” she says.

Refer a Patient

For patients with complex hypoglycemia, timely access to coordinated, multidisciplinary care can significantly impact outcomes.

For more information about our Hypoglycemia Program or to refer a patient, call 513-636-4744. You can also email hypoglycemia@cchmc.org.

(Published April 2026)

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