True Hyperinsulinism Versus Functional Hypoglycemia

In hyperinsulinism, as differentiated from functional or spontaneous hypoglycemia, the patient shows symptoms of receiving too much insulin either by injection or from an insulin-producing tumor.Criteria for diagnosis of hyperinsulinism are (1) attacks associated with fasting or exercise, or both; (2) blood sugar of less than 50 mg. per 100 cc. during an attack; and (3) prompt relief of attacks with orally administered glucose or intravenously administered dextrose.When it has been determined that a patient with hyperinsulinism is not receiving insulin surreptitiously and when removal of three-fourths of the pancreas has failed to relieve the hypoglycemia, total pancreatectomy is advised.