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Respiratory Metabolism Studies in Hyperinsulinism Following Ingestion of Glucose¹

Department of Metabolism, The Montreal General Hospital, Montreal, Canada

Simultaneous blood sugar and respiratory metabolism time curves were obtained in five cases of hyperinsulinism after oral administration of glucose.

In each case, the diagnosis of hyperinsulinism was based upon the history and blood sugar findings; the patients complained of weakness, fatigue, hunger, etc., which appeared within a few hours after meals and were relieved by taking carbohydrate-containing foods; and, in each case, repeated blood sugar time curves obtained after administration of glucose were flat; hyperglycemic response to the ingested glucose was inappreciable or absent.

According to the respiratory metabolism data, the response to glucose ingestion may be oxidation or storage; and it would appear that the type of response depends upon the amount of glycogen in the body. With a poor supply of glycogen, the tendency is toward storage and, when the diet is liberal with respect to carbohydrates, the tendency is toward oxidation.

As in all of these cases the clinical histories and symptoms were essentially the same, it would appear that the symptoms of spontaneous hyperinsulinism are largely independent of the glycogen content of the body and are due essentially to disappearance of sugar from the blood stream. Either oxidation or storage may affect such disappearance. The condition thus resembles insulin shock due to insulin injections.

No proof was found that the rate of oxidation of administered carbohydrates is increased in hyperinsulinism. As a matter of fact, the average values suggested a decrease and corresponded somewhat to those obtained by simultaneously administered glucose and insulin in normal (non-diabetic) individuals.

Manuscript received 6 July 1934.