Stanley C A, Baker L
Pediatrics. 1976 May;57(5):702-11.
The metabolic adaptation to fasting in infants with hyperinsulinism was examined to see whether a characteristic abnormality could be found that would aid in the diagnosis of this disorder. Seven infants under 1 year of age with hyperinsulinism were studied; 7 control infants of similar age and 12 children with ketotic hypoglycemia served as contrast groups. At the time of hypoglycemia, four of the seven infants with hyperinsulinism did not have elevated levels of insulin. However, levels of beta-hydroxybutyrate were significantly lower in the infants with hyperinsulinism than in the control and ketotic hypoglycemic groups. Levels of free fatty acids were also lower in the infants with hyperinsulinism. Expected levels and normal limits for beta-hydroxybutyrate, insulin, and free fatty acids when plasma glucose is below 40 mg/100 ml were estimated by combining the control and ketotic hypoglycemic groups. Using these values as standards, the diagnosis of hyperinsulinism can be made by evaluation of the response to fasting hypoglycemia. The application of this approach is illustrated by three case examples.
对患有高胰岛素血症的婴儿禁食时的代谢适应性进行了研究，以确定是否能发现有助于诊断该疾病的特征性异常。研究了7名1岁以下患有高胰岛素血症的婴儿；7名年龄相仿的对照婴儿和12名患有酮症性低血糖的儿童作为对比组。在低血糖发生时，7名患有高胰岛素血症的婴儿中有4名胰岛素水平未升高。然而，患有高胰岛素血症的婴儿中β-羟基丁酸水平显著低于对照组和酮症性低血糖组。患有高胰岛素血症的婴儿游离脂肪酸水平也较低。通过合并对照组和酮症性低血糖组来估计当血浆葡萄糖低于40mg/100ml时β-羟基丁酸、胰岛素和游离脂肪酸的预期水平及正常范围。以这些值作为标准，可通过评估对禁食低血糖的反应来诊断高胰岛素血症。三个病例示例说明了该方法的应用。
