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Fasting Hypoglycemia in Adults

Fasting Hypoglycemia in Adults Abstract MaryBeth Pereira, MD, Assistant Resident in Medicine, the Jewish Hospital of St Louis: A 43-year-old man was admitted to the hospital for the evaluation of syncope. His illness began approximately 12 months before admission, when he began to experience recurrent episodes of light-headedness. Four months before admission, he decided to seek medical attention, and arrangements for an oral glucose tolerance test were made. On the way to this test, he became light-headed, which resulted in an automobile accident. When he was examined at a nearby emergency room, a random blood glucose level was noted to be 40 mg/dL. He received a hypoglycemic diet, which consisted of frequent small feedings, but no further diagnostic workup was obtained. Two months before admission, he suffered an episode of complete loss of consciousness, which motivated him to seek additional medical advice. During the preceding six months, he had gained 7 kg, but he denied References 1. Cryer PE: Diagnostic Endocrinology , ed 2. New York, Oxford University Press, 1979. 2. Permutt MA: Postprandial hypoglycemia. Diabetes 1976;25:719-733.Crossref 3. Froesch ER, Wolf HP, Baitsch H, et al: Hereditary fructose intolerance: An inborn defect of hepatic fructose-1-phosphate splitting aldolase. Am J Med 1963;34:151-167.Crossref 4. Fariss BL: Prevalence of post-glucose load glycosuria and hypoglycemia in a group of healthy young men. Diabetes 1974;23:189-191. 5. Jung Y, Khurana RC, Corredor DG, et al: Reactive hypoglycemia in women: Results of a health survey. Diabetes 1971;20:428-434. 6. Merimee TJ, Tyson JE: Stabilization of plasma glucose during fasting: Normal variations in two separate studies. N Engl J Med 1974;291:1275-1278.Crossref 7. Felig P, Lynch V: Starvation in human pregnancy: Hypoglycemia, hypoinsulinemia and hyperketonemia. Science 1970;170:990-992.Crossref 8. Pagliara AS, Karl IE, Haymond MW, et al: Hypoglycemia in infancy and childhood. J Pediatr 1973;82:365-367, 558-577.Crossref 9. Chaussain JL: Glycemic response to 24-hour fast in normal children and children with ketotic hypoglycemia. J Pediatr 1973;82:438-443.Crossref 10. Becker K: Beta cell nesidioblastosis. Eur J Pediatr 1978;127:75-89.Crossref 11. Stanley GC, Baker L: Hyperinsulinism in infancy: Diagnosis by demonstration of abnormal response to fasting hypoglycemia. Pediatrics 1976;57:702-711. 12. Fajans SS, Floyd JC: Diagnosis and medical management of insulinomas. Ann Rev Med 1979;30:313-329.Crossref 13. Cahill GF: Physiology of insulin in man. Diabetes 1971;20:785-799. 14. McGarry JD, Foster DW: Regulation of ketogenesis and clinical aspects of the ketotic state. Metabolism 1972;21:471-489.Crossref 15. Cahill GF: Starvation in man. N Engl J Med 1970;282:668-675.Crossref 16. Jordan RM, Kammer H, Riddle MR: Sulfonylurea-induced factitious hypoglycemia: A growing problem. Arch Intern Med 1977;137:390-393.Crossref 17. Service FJ, Palumbo PJ: Factitial hypoglycemia: Three cases diagnosed on the basis of insulin antibodies. Arch Intern Med 1974;134:336-340.Crossref 18. Scarlett JA, Mako ME, Rubenstein AH, et al: Factitious hypoglycemia: Diagnosis by measurement of c-peptide immunoreactivity and insulinbinding antibodies. N Engl J Med 1977;297:1029-1032.Crossref 19. Couropmitree C, Freinkel N, Nagel TC, et al: Plasma c-peptide and diagnosis of factitious hyperinsulinism: Study of an insulin-dependent diabetic patient with 'spontaneous' hypoglycemia. Ann Intern Med 1975;82:201-204.Crossref 20. Fajans SS, Floyd JC: Fasting hypoglycemia in adults. N Engl J Med 1976;294:766-772.Crossref 21. Service FJ, Dale AJD, Elveback LR, et al: Insulinoma: Clinical and diagnostic features in 60 consecutive cases. Mayo Clin Proc 1976;51:417-429. 22. Gutman RA, Lozarus NR, Penkas JC, et al: Circulating proinsulin like material in functioning insulinomas. N Engl J Med 1971;284:1003.Crossref 23. Rubenstein AH, Kuzuya H, Horwitz DL: Clinical significance of circulating C-peptide in diabetes mellitus and hypoglycemic disorders. Arch Intern Med 1977;137:625-632.Crossref 24. Turner RC, Heding LG: Plasma proinsulin, c-peptide and insulin in diagnostic suppression tests for insulinomas. Diabetologia 1977;13:571-577.Crossref 25. Genuth SM: Plasma insulin and glucose profiles in normal, obese and diabetic persons. Ann Intern Med 1973;79:812-822.Crossref 26. Fajans SS, Schneider JM, Schteingart DE, et al: The diagnostic value of sodium tolbutamide in hypoglycemic states. J Clin Endocrinol Metab 1961;21:371-386.Crossref 27. Oneda A, Maruhama Y, Itabashi H, et al: Diagnostic value of intravenous glucagon test in insulinoma. Tohoku J Exp Med 1975;116:205-211.Crossref 28. Hawkins RD, Kalant H: The metabolism of ethanol and its metabolic effects. Pharmacol Rev 1972;24:67-157. 29. Kreisberg R, Siegal A, Owen W: Glucose-lactate interrelationships: Effect of ethanol. J Clin Invest 1971;50:175-185.Crossref 30. Rutsky EA, McDaniel HG, Tharpe DC, et al: Spontaneous hypoglycemia in chronic renal failure. Arch Intern Med 1978;138;1364-1368.Crossref 31. Garber AJ, Bier DM, Cryer PE, et al: Hypoglycemia in compensated chronic renal insufficiency: Substrate limitation of gluconeogenesis. Diabetes 1974;23:982-986. 32. Cryer PE, Kissane JM: Arthropathy, carpal tunnel syndrome and renal failure. Am J Med 1979;66:1015-1024.Crossref 33. Mako ME, Block M, Starr JI, et al: Proinsulin in chronic renal and hepatic failure: A reflection of the relative contribution of the liver and kidney to its metabolism, abstracted. Clin Res 1973;21:631. 34. Kreisberg RA, Pennington LF: Tumor hypoglycemia: A heterogenous disorder. Metabolism 1970;19:445-452.Crossref 35. Megyesi K, Kahn CR, Roth J, et al: Hypoglycemia in association with extra-pancreatic tumors: Demonstration of elevated plasma NSILA-S by a new radioreceptor assay. J Clin Endocrinol Metab 1974;38:931-934.Crossref 36. Kudlow JE, Albisser AM, Angel A, et al: Insulinoma resection facilitated by the artificial endocrine pancreas. Diabetes 1978;27:774-777.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340160049012
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Abstract

Abstract MaryBeth Pereira, MD, Assistant Resident in Medicine, the Jewish Hospital of St Louis: A 43-year-old man was admitted to the hospital for the evaluation of syncope. His illness began approximately 12 months before admission, when he began to experience recurrent episodes of light-headedness. Four months before admission, he decided to seek medical attention, and arrangements for an oral glucose tolerance test were made. On the way to this test, he became light-headed, which resulted in an automobile accident. When he was examined at a nearby emergency room, a random blood glucose level was noted to be 40 mg/dL. He received a hypoglycemic diet, which consisted of frequent small feedings, but no further diagnostic workup was obtained. Two months before admission, he suffered an episode of complete loss of consciousness, which motivated him to seek additional medical advice. During the preceding six months, he had gained 7 kg, but he denied References 1. Cryer PE: Diagnostic Endocrinology , ed 2. New York, Oxford University Press, 1979. 2. Permutt MA: Postprandial hypoglycemia. Diabetes 1976;25:719-733.Crossref 3. Froesch ER, Wolf HP, Baitsch H, et al: Hereditary fructose intolerance: An inborn defect of hepatic fructose-1-phosphate splitting aldolase. Am J Med 1963;34:151-167.Crossref 4. Fariss BL: Prevalence of post-glucose load glycosuria and hypoglycemia in a group of healthy young men. Diabetes 1974;23:189-191. 5. Jung Y, Khurana RC, Corredor DG, et al: Reactive hypoglycemia in women: Results of a health survey. Diabetes 1971;20:428-434. 6. Merimee TJ, Tyson JE: Stabilization of plasma glucose during fasting: Normal variations in two separate studies. N Engl J Med 1974;291:1275-1278.Crossref 7. Felig P, Lynch V: Starvation in human pregnancy: Hypoglycemia, hypoinsulinemia and hyperketonemia. Science 1970;170:990-992.Crossref 8. Pagliara AS, Karl IE, Haymond MW, et al: Hypoglycemia in infancy and childhood. J Pediatr 1973;82:365-367, 558-577.Crossref 9. Chaussain JL: Glycemic response to 24-hour fast in normal children and children with ketotic hypoglycemia. J Pediatr 1973;82:438-443.Crossref 10. Becker K: Beta cell nesidioblastosis. Eur J Pediatr 1978;127:75-89.Crossref 11. Stanley GC, Baker L: Hyperinsulinism in infancy: Diagnosis by demonstration of abnormal response to fasting hypoglycemia. Pediatrics 1976;57:702-711. 12. Fajans SS, Floyd JC: Diagnosis and medical management of insulinomas. Ann Rev Med 1979;30:313-329.Crossref 13. Cahill GF: Physiology of insulin in man. Diabetes 1971;20:785-799. 14. McGarry JD, Foster DW: Regulation of ketogenesis and clinical aspects of the ketotic state. Metabolism 1972;21:471-489.Crossref 15. Cahill GF: Starvation in man. N Engl J Med 1970;282:668-675.Crossref 16. Jordan RM, Kammer H, Riddle MR: Sulfonylurea-induced factitious hypoglycemia: A growing problem. Arch Intern Med 1977;137:390-393.Crossref 17. Service FJ, Palumbo PJ: Factitial hypoglycemia: Three cases diagnosed on the basis of insulin antibodies. Arch Intern Med 1974;134:336-340.Crossref 18. Scarlett JA, Mako ME, Rubenstein AH, et al: Factitious hypoglycemia: Diagnosis by measurement of c-peptide immunoreactivity and insulinbinding antibodies. N Engl J Med 1977;297:1029-1032.Crossref 19. Couropmitree C, Freinkel N, Nagel TC, et al: Plasma c-peptide and diagnosis of factitious hyperinsulinism: Study of an insulin-dependent diabetic patient with 'spontaneous' hypoglycemia. Ann Intern Med 1975;82:201-204.Crossref 20. Fajans SS, Floyd JC: Fasting hypoglycemia in adults. N Engl J Med 1976;294:766-772.Crossref 21. Service FJ, Dale AJD, Elveback LR, et al: Insulinoma: Clinical and diagnostic features in 60 consecutive cases. Mayo Clin Proc 1976;51:417-429. 22. Gutman RA, Lozarus NR, Penkas JC, et al: Circulating proinsulin like material in functioning insulinomas. N Engl J Med 1971;284:1003.Crossref 23. Rubenstein AH, Kuzuya H, Horwitz DL: Clinical significance of circulating C-peptide in diabetes mellitus and hypoglycemic disorders. Arch Intern Med 1977;137:625-632.Crossref 24. Turner RC, Heding LG: Plasma proinsulin, c-peptide and insulin in diagnostic suppression tests for insulinomas. Diabetologia 1977;13:571-577.Crossref 25. Genuth SM: Plasma insulin and glucose profiles in normal, obese and diabetic persons. Ann Intern Med 1973;79:812-822.Crossref 26. Fajans SS, Schneider JM, Schteingart DE, et al: The diagnostic value of sodium tolbutamide in hypoglycemic states. J Clin Endocrinol Metab 1961;21:371-386.Crossref 27. Oneda A, Maruhama Y, Itabashi H, et al: Diagnostic value of intravenous glucagon test in insulinoma. Tohoku J Exp Med 1975;116:205-211.Crossref 28. Hawkins RD, Kalant H: The metabolism of ethanol and its metabolic effects. Pharmacol Rev 1972;24:67-157. 29. Kreisberg R, Siegal A, Owen W: Glucose-lactate interrelationships: Effect of ethanol. J Clin Invest 1971;50:175-185.Crossref 30. Rutsky EA, McDaniel HG, Tharpe DC, et al: Spontaneous hypoglycemia in chronic renal failure. Arch Intern Med 1978;138;1364-1368.Crossref 31. Garber AJ, Bier DM, Cryer PE, et al: Hypoglycemia in compensated chronic renal insufficiency: Substrate limitation of gluconeogenesis. Diabetes 1974;23:982-986. 32. Cryer PE, Kissane JM: Arthropathy, carpal tunnel syndrome and renal failure. Am J Med 1979;66:1015-1024.Crossref 33. Mako ME, Block M, Starr JI, et al: Proinsulin in chronic renal and hepatic failure: A reflection of the relative contribution of the liver and kidney to its metabolism, abstracted. Clin Res 1973;21:631. 34. Kreisberg RA, Pennington LF: Tumor hypoglycemia: A heterogenous disorder. Metabolism 1970;19:445-452.Crossref 35. Megyesi K, Kahn CR, Roth J, et al: Hypoglycemia in association with extra-pancreatic tumors: Demonstration of elevated plasma NSILA-S by a new radioreceptor assay. J Clin Endocrinol Metab 1974;38:931-934.Crossref 36. Kudlow JE, Albisser AM, Angel A, et al: Insulinoma resection facilitated by the artificial endocrine pancreas. Diabetes 1978;27:774-777.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1982

References