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Postgastrectomy Hypoglycemia: A New Look

JAMA. 1971;217(5):689. doi:10.1001/jama.1971.03190050145015.
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"Behind Appearances"1 is the title of a fascinating book which, with beautiful illustrations and thought-provoking text, traces the still-developing foundations of science, and sometimes of philosophy, upon which much of art, perhaps unwittingly, is built. In a quite different context, science itself has its own "behind appearances." New quirks that turn up in long-accepted verities alert the curious investigator to search beyond what meets the eye, with the result that old concepts are modified, abandoned, or confirmed.

Such is the case with postgastrectomy hypoglycemia, often a late component of the dumping syndrome. For many years it has been assumed, logically enough, that the low levels of blood glucose observed two to three hours after ingestion of a carbohydrate meal are attributable to the hypersecretion of insulin in response to the high and prolonged hyperglycemia induced by the rush of food into the intestine. That this chain of events does


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