From: young@serum.kodak.com (Rich Young)
Newsgroups: rec.food.veg
Subject: Re: Hypoglycemia
Date: 16 Nov 92 23:48:52 GMT
Article-I.D.: pixel.1992Nov16.234852.28892
Reply-To: young@serum.kodak.com
Organization: Clinical Diagnostics Division, Eastman Kodak Company
Originator: young@sasquatch


   OK, since we didn't get any useful information from the Physicians'
   Committee for (Ir)Responsible Medicine, I'll perform a service for which
   I know I'll be roundly flamed...in the interest of accurate information.

   From the MERCK MANUAL, 16th edition, 1992.  [Which, for the benefit of
   the conspiracy theorists, can be ordered in the U. S. from either the
   B. Dalton or Walden book stores by anyone with sufficient literacy to
   read this posting.]

	MAJOR CAUSES OF HYPOGLYCEMIA:

	    Drugs (the most common cause)

		Insulin, alcohol, and sulfonylureas account for more than
		   50% of all hospitalized cases.

		Other occasional drug-induced causes

		   Salicylates (aspirin and like products)
		   Propranolol
		   Pentamidine
		   Disopyramide
		   Hypoglycine A (unripened akee fruit)
		   Quinine in falciparum malaria

	    Non-drug induced

		Fasting hypoglycemia

		   Characteristically present in infancy or childhood

			Nesidioblastosis
			Ketotic hypoglycemia
			Inherited hepatic enzyme deficiencies that restrict
			  hepatic glucose release:

				glucose-6-phosphatase
				phosphorylase
				pyruvate carboxylase
				phosphoenolpyruvate carboxykinase
				fructose-1, 6-diphosphatase
				glycogen synthetase

			Inherited defects in fatty acid oxidation including
			  systemic carnitine deficiency

			Inherited defects in ketogenesis

		   Characteristically or more commonly present in adults

			Islet cell adenoma or carcinoma
			Hypoglycemia associated with large mesenchymal tumors
			Autoimmune hypoglycemia in nondiabetics
			Insulin-receptor antibody hypoglycemia
			Severe liver disease
			Severe renal disease

		   Less age-restricted causes

			Cachexia
			Endotoxic shock
			Hypopituitarism with deficiency of both growth
			  hormone and cortisol

		Reactive hypoglycemia

		   Characteristically present in infancy or childhood

			Hereditary fructose intolerance
			Galactosemia
			Leucine sensitivity

		   Characteristically present in adults

			Alimentary hypoglycemia (should be considered only in
			  patients with prior upper GI surgery who have post-
			  prandial adrenergic symptoms that are selectively
			  corrected by carbohydrate ingestion.)

			Idiopathic alimentary hypoglycemia (is extremely rare;
			  a diagnosis should be considered only when the
			  patient is emotionally stable and the history
			  clearly indicates that recurrent adrenergic symptoms
			  are selectively provoked by meals and are rapidly
			  corrected only by carbohydrate ingestion.)

			Early noninsulin-dependent diabetes mellitus (?)

			[NOTE: the question mark above is in the original
				text.]

   There is also this:

	ERRONEOUS DIAGNOSES OF "REACTIVE (ALIMENTARY) HYPOGLYCEMIA" in
	patients without prior upper GI surgery are common.  Post-prandial
	symptoms that are not selectively corrected by ingesting carbohydrate
	are common, frequently occurring during emotional stress, and can
	become the focus of an anxiety state.  The history usually
	distinguishes these patients, but many are needlessly subjected to
	a 5-h OGTT and misdiagnosed as having reactive hypoglycemia because
	of one of the variations in OGTT that occur in many asymptomatic,
	normal patients.  THE OGTT IS NOT A VALID MEANS OF DIAGNOSING
	ALIMENTARY HYPOGLYCEMIA.

	[NOTE: all emphasis is in the original text.]


-Rich Young (These are not Kodak's opinions.)