Hypoglycaemia and Diabetes

Robert Daniel Lawrence (1 892-1 968) was accorded a position which is denied to most physicians. He became a prominent specialist in a disorder from which he himself suffered for most of his professional career. He was therefore in a unique position to study the effects of insulin therapy at first hand. In a manner characteristic of his subsequent approach to scientific research, he kept careful and detailed notes of his personal experience with the hormone which revolutionized the treatment of severe diabetes. On 31 May 1923, he documented his initial encounter with insulin-induced hypoglycaemia (Figure 11, observing that he felt 'just a little shaky' several hours after injecting insulin, and the following day was 'slightly faint, dizzy, weak and tremulous.' He subsequently wrote: 'I felt weak, sweaty, with an intense hunger, which led me to the biscuit box and slow restoration, obviously my first hypoglycaemic attack'. ' Although diverse symptoms of hypoglycaemia can occur,' this description by Lawrence illustrates the dual symptomatology of this unphysiological state: a combination of neuroglycopenia and autonomic neural stimulation.