The following abstracts conclude the proceedings of the Diabetes course presented by the E. Bunts Educational Institute on March 17, 1949. The first portion of these proceedings appeared in the July issue of the Cleveland Clinic Quarterly.
R. W. Schneider, M.D.
Rational management of the many causes of hypoglycemia must be directed at the surgical removal of the cause, or the employment of medical measures designed to control the occurrence of low blood sugars. Surgery is indicated in only a small percentage. Among the larger medical group, dietary management highly successful in controlling one type, may at times intensify the hypoglycemia in others. Differential diagnosis at times may depend upon such a therapeutic test. Approximately 80 per cent of all cases are of functional origin. The hypoglycemia attending Addison’s disease, Simmond’s disease, severe renal glycosuria, lactation, Von Gierke’s disease, severe inanition, or following gastric resection are usually quite easily recognized. Liver disease does not usually produce significant hypoglycemia until advanced hepatic insufficiency has occurred. By this time such patients are generally gravely ill and show other clinical signs of liver disease. Hypoglycemia associated with pituitary failure is less readily separated, but here there may be x-ray evidence of destruction of the clinoid processes, visual field changes, low urinary excretion of follicle-stimulating hormone and 17-ketosteroids, as well as clinical evidence of hypogonadism.
In hyperinsulinism due to islet cell adenoma, islet cell hyperplasia, or islet cell carcinoma, the patient usually has some type of spell or attack. Usually, each attack follows. . .