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May 31, 1930


Author Affiliations


JAMA. 1930;94(22):1739-1742. doi:10.1001/jama.1930.02710480015005

In the era of undernutrition in diabetic therapy, low blood sugar was observed in several cases of severe diabetes.1 With the introduction of insulin, "the symptom-complex hypoglycemia" became of more general interest.2 It was appreciated both then and later3 that symptoms were not an invariable accompaniment of low blood sugar; many authors have shown that they appear at varying levels.4

The syndrome of spontaneous hypoglycemia without diabetes was described in 1924 by Harris,5 who thought it due to hyperinsulinism or dysinsulinism. Wilder, Allan, Power and Robertson6 three years later published full clinical, biochemical and pathologic studies of a case of severe hypoglycemia arising from carcinoma of the pancreatic islands with metastases. The liver in this case was loaded with glycogen, but injection of epinephrine as well as of pituitary extract failed to elevate the blood sugar. When these extracts fail to elevate low blood

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