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THE BLOOD SUGAR DURING AND AFTER THE HYPOGLYCEMIC COMA OF INSULIN SHOCK THERAPY, WITH SPECIAL REFERENCE TO THE "AFTERSHOCK"
MARCEL HEIMAN
Am J Psychiatry 1942;98:863-873.
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The State Hospital, Mt. Pleasant, Iowa.

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Abstract

1. Coma due to administered insulin does not generally occur while the blood sugar drops.2. The blood sugar remains at about the same level after the lowest point has been reached throughout the coma.3. Following the termination of the insulin coma, the blood sugar describes a characteristic curve with a sharp ascending and descending branch. In a majority of patients the blood sugar drops to hypoglycemic levels.4."Aftershock" occurs a definite time, 4 to 6 hours, following the termination of the insulin coma, more frequently in female patients.5. The "Aftershock" is due to a spontaneous hypoglycemia and occurs suddenly, probably simultaneously with the dropping of the blood sugar.6. The spontaneous hypoglycemia is due either to a depletion of glycogen in the liver, or to a functional disturbance in the carbohydrate metabolism. This disturbance is of a temporary nature, as found in patients with faulty dietary habits.7. The spontaneous hypoglycemia calls forth the same response as the hypoglycemia due to administered insulin, namely, a stimulation of the adrenosympathetic system.8. The "aftershock" not infrequently has appeared to produce a marked clinical improvement. This improvement may be utilized for practical purposes.9. The "aftershock" can be avoided by administration of carbohydrate 3 to 4 hours following the termination of the insulin coma.

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