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Hypoglycemia in man pathologic and physiologic variants.

T J Merimee, J E Tyson

    Diabetes
    |March 1, 1977
    PubMed
    Summary
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    The insulin-to-glucose (I/G) ratio pattern effectively distinguishes fasting hypoglycemia from insulinomas. Changes in the I/G ratio, not just glucose levels, are key for accurate diagnosis.

    Area of Science:

    • Endocrinology
    • Metabolic Disorders
    • Clinical Diagnostics

    Background:

    • Distinguishing physiologic hypoglycemia during fasting from pathologic hypoglycemia, particularly that caused by insulinomas, is clinically significant.
    • Plasma glucose levels alone are insufficient for differentiating these conditions accurately.

    Purpose of the Study:

    • To evaluate the effectiveness of the immunoreactive-insulin-to-glucose (I/G) ratio pattern in distinguishing physiologic fasting hypoglycemia from pathologic hypoglycemia in various subject groups.
    • To assess the diagnostic utility of plasma glucose values and basal I/G ratios compared to the dynamic change in the I/G ratio during a 72-hour fast.

    Main Methods:

    • Conducted 72-hour fasts in individuals of normal weight (men and women), obese subjects, and patients with diagnosed insulinomas.

    Related Experiment Videos

  • Measured plasma glucose and immunoreactive insulin levels at 12-hour intervals throughout the fasting period.
  • Calculated the insulin-to-glucose (I/G) ratio at each time interval and analyzed the pattern of change, alongside basal I/G ratios and absolute glucose values.

    • Main Results:

    • The pattern of change in the I/G ratio during fasting clearly distinguished between normal individuals, obese subjects, and patients with insulinomas.
    • Plasma glucose values alone could not reliably differentiate these groups.
    • While basal I/G ratios showed overlap between simple obesity and insulinoma patients, the dynamic change in the I/G ratio was independent of measurement techniques and provided a clear distinction.

    Conclusions:

    • The pattern of change in the insulin-to-glucose (I/G) ratio during a 72-hour fast is a highly effective method for distinguishing physiologic fasting hypoglycemia from pathologic hypoglycemia caused by insulinomas.
    • Basal I/G ratios can be misleading due to overlap; therefore, analyzing the ratio's dynamic change is crucial for accurate diagnosis.
    • This method offers a reliable diagnostic tool, independent of specific glucose and insulin assay techniques.