Glucose-Resistant Hypoglycemia in Inanition

To the Editor.  —In the April Archives (1982;142:743-746), Elias and Gwinup described a glucose-resistant hypoglycemia in adults with inanition. They suggested that this may be due to abnormally increased glucose consumption by most of the insulin-dependent and insulin-independent cells. The hypoglycemia appeared in one instance to be responsive to treatment with methylprednisolone. Another common feature of the condition described in their report is a disordered sensorium.We recently reported similar observations^1,2 of three well-nourished children, who had viral infections resulting in a Reye's syndrome—like illness with early seizures, a disease calledSingapore syndrome. We suggested that glucose transport can become upset during viral infections, resulting in intracellular glucose starvation. At hospital admission, the blood glucose levels in two of the children were 6 and 45 mg/dL, while, in the third child, it was 56 mg/dL (Figure 1).