Although average fasting blood glucose levels are lower in victims of famine than in well-fed populations, overt hypoglycemia is rare. Even in patients suffering from kwashiorkor, hypoglycemia is uncommon and is usually associated with infection, hypothermia, and coma. Patients with anorexia nervosa develop hypoglycemia only as an agonal phenomenon and its appearance generally portends imminent death. The characteristic clinical biochemistry findings are of low or undetectably low plasma insulin, proinsulin, C-peptide, and IGF-1 levels, grossly depressed plasma nonesterified fatty acids (NEFA) and /3-hydroxybutyrate, and elevated growth hormone and cortisol levels. Relief of hypo-glycemia by re-feeding is the only measure carrying any chance of preventing death, but it is rarely successful.

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