To the Editor:—
I would suggest that myocardial glycopenia due to hypoglycemic attacks be seriously entertained. In studying scores of comparable challenging cases, I have demonstrated the presence of diabetogenic hyperinsulinism in the vast majority (Clin Res13:28, 1965). Occasionally, it could be convincingly documented only by the method of afternoon glucosetolerance testing (J Amer Geriatric Soc12:423, 1964) because of the cyclic intensification of insulinogenesis as the day advances. Major coronary artery stenosis or occlusion was not found in several such patients who experienced nocturnal exacerbations of typical angina pectoris, either by careful angiographic studies or direct examination at the time of surgery. The institution of a corrective diet aimed at preventing severe reactive hypoglycemia day and night promptly ameliorated and indefinitely prevented or minimized both nocturnal angina pectoris and associated abdominal or leg cramps in most of these patients, notwithstanding previous refractoriness to divers therapeutic measures.