Plasma Insulin in Reactive Hypoglycemia

Among 663 standard four-hour oral glucose tolerance tests (OGTT) performed in a Department of Internal Medicine, forty-seven curves demonstrated reactive hypoglycemia of 45 mg. per 100 ml. or less at one or more occasions. Subsequent analysis of the records of the corresponding patients allows their partition into the following groups: IA. Obesity (11), IB. Obesity with chemical diabetes (9), II. Postgastrectomy syndrome (3), III. Chemical diabetes without obesity (1), IV. Renal glycosuria (7), V. Isolated reactive hypoglycemia (16). In order to determine the role of plasma insulin in the pathogenesis of the syndrome, the insulin response of each group of subjects presenting reactive hypoglycemia was compared to that of a control group of similar age, sex and weight with similar pathological findings but without reactive hypoglycemia. The results indicate that plasma insulin values can not account for the reactive hypoglycemia in the groups IA, IB, III and IV, and thus other factors may be responsible for the occurrence of hypoglycemia in most cases of this syndrome. In contrast, an exaggerated insulin response exists in group II, and in seven out of the sixteen cases of isolated reactive hypoglycemia. No correlation was found between the presence of clinical symptoms evoking reactive hypoglycemia during the usual life and the severity of the hypoglycemia recorded during the OGTT.