After the discovery of insulin in 1922 the signs and symptoms of acute hypoglycemia became well known. These, in cases of mild involvement, were weakness, perspiration and anxiety and in severe instances more serious mental changes, convulsions, coma and death. The mental changes have received more attention lately, especially in association with insulin therapy in some of the psychoses. Apparently the hypoglycemic effect on nervous tissue may reach a point at times which is irreversible. Malamud and Grosh1 and Klein and Ligterink2 have discussed this problem recently.
Hypoglycemia may be due to many causes—pituitary tumors; adrenal cortical tumors; advanced hepatic disease such as yellow atrophy, carcinoma or fatty infiltration in which 70 to 80 per cent of hepatic substance is replaced; cachectic states; excessive physical exercise, and, most spectacularly, to tumors of the island cells of the pancreas.
Since Harris3 first described this condition as hyperinsulinism in