Glucose-Resistant Hypoglycemia in Inanition

• Three patients had starvation-related hypoglycemia that was not responsive to the infusion of glucose. The patients resembled fatal cases of hypoglycemia seen very rarely in victims of kwashiorkor. None of the patients had a history of drug ingestion, nor was there any evidence of endocrine insufficiency. Two of the patients had low serum insulin levels. Complete postmortem examinations were done for all three patients and there was no evidence of islet cell abnormalities or of malignant neoplasms. A syndrome of severe hypoglycemia refractory to therapy, that was occasionally seen, in years past, in starved individuals is confirmed. The mechanisms underlying the disorder are obscure, but a failure of glycogenolysis, neoglucogenesis, or overproduction of insulin appear unlikely possibilities. It is postulated that cells normally impermeable to glucose, when serum insulin levels are low, become permeable in some severely starved patients, for reasons unknown.

(Arch Intern Med 1982;142:743-746)