Alcohol Hypoglycemia

Abstract

Within the last two years, it has been shown that pure ethanol * can elicit hypoglycemia when administered after appropriate periods of fasting.^1-4In normal subjects, a minimum of two to three days of starvation is necessary.^1,3,4On the other hand, in subjects with marginal gluconeogenic reserve, only overnight fast may be required.^1,2In both situations, the hypoglycemia is not responsive to glucagon^2-4and it is not attended by elevations of plasma insulin.^1,2,5Direct in vitro studies have indicated that lowering of blood sugar may be ascribed, at least in part, to an interference with intrahepatic mechanisms for gluconeogenesis from smaller carbon fragments.^1,6 Since ketogenesis and gluconeogenesis usually increase in concert during starvation, we have attempted to assess whether the ethanol-induced hypoglycemia is accompanied by alterations in plasma ketones. For our studies, we have employed "juvenile" diabetics from whom short-acting (ie, "regular") insulin was withheld