Metabolism in Organic Hyperinsulinism

Reactive Hyperinsulinism

“…for a period of two to three hours. However, in their report two cases diverged from this type and gave low flat curves-a fincing also observed by Conn and Conn (1941).…”

“…However, there are apparently certain points that may be of diagnostic value. For instance, Conn (1940) considers that the presence of a low value for the fasting blood sugar before breakfast, the diet being normal, is a point strongly in favour of organic disease. It is well known that there is no relation between the blood-sugar level and the severity of a hypoglycaemic attack, although many of the cases do in fact have such attacks at this time.…”

“…The second point for special examination is the shape of the glucosetolerance curve. Conn and Conn (1941) consider that in " functional hyperinsulinism" the blood-sugar level shows a precipitate fall after a large amount of carbohydrate. Examination of the case reports of Finney and Finney (1928), Feinier et al BRITISH MEDICAL JOURNAL (1935-6), and Fraser et al (1938) show, for example, sugartolerance tests of the "plateau type."…”

“…In general it appears that the more severe they are, without any tendency to spontaneous alleviation if glucose is not given, and the more irregular their onset, the more likely is organic disease. Conn (1940) and Harris (1936-7) both gave criteria indicating the necessity for laparotomy, the latter author suggesting that the inability to control the attacks by diet within a few weeks should be taken into account. Allen (1941) considered that the ability to control symptoms by means of a high-protein diet is indicative of but a mild degree of insulin excess.…”

“…It is the object of this communication to draw attention to a condition which may be termed " reaQtive hyperinsulinism," as opposed to hyperinsulinism due to overactivity of the pancreas as a result of tumour of the islets, malignant or benign. The term " reactive hyperinsulinism" is to be preferred to that of "functional hyperinsulinism " of Conn (1940), since the word " functional" has other less well defined associations.…”