Intentional hypoglycaemia in diabetic patients treated with insulin
Keywords:
intentional hypoglycaemia, diabetes mellitus, psychiatric disorderAbstract
Introduction: Hypoglycaemia is the significant limiting factor in management of diabetes. It causes a recurrent morbidity and impairs quality of life in most patients, especially those with Type 1 diabetes. Non-iatrogenic hypoglycaemia in a diabetic patient presents a difficult diagnostic challenge. It could be a consequences of deliberately use of insulin or insulin secretegogues (factitious hypoglycaemia, malingering) or organic diseases (insulinoma).
Cases report: Two diabetic patients with surreptitious episodes of hypoglycaemia due to intentional application of insulin are described. This condition has to be suspected in unexplained recurrent episodes of hypoglycaemia. In these cases determination of C-peptide and insulin levels should be considered prior to other more invasive and expensive diagnostic procedures
Conclusions: The authors believe that early and correct diagnosis of intentional hypoglycaemia prevents unnecessary diagnostic and therapeutic procedures as well as possible morbidity and mortality. The aim of the present report is to remind the medical personnel, especially in the emergency departments, of this often overlooked condition.
Downloads
References
Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of type I and type II diabetes. Diabetologia 2002; 45: 937–48.
Charlton R, Smith G, Day A. Munchausen’s syndrome manifesting as factitious hypoglycaemia. Diabetologia 2001; 44: 784–5.
Sheehy TW. Case report: Factitious hypoglycaemia in diabetic patient. Am J Med Sci 1992; 304: 298–302.
Grunberger G, Weiner JL, Silverman R, Taylor S, Gorden P. Factitious hypoglycaemia due to surreptitious administration of insulin. Ann Intern Med 1988; 108: 252–7.
Svartberg J, Stridsberg M, Wilander E, Anderson DEH, Eriksson B. Tumor-induced hypoglycaemia in a patient with insulin-dependent diabetes mellitus. J Intern Med 1996; 239: 181–5.
Elwyn TS, Ahmed I. Factitious disorder. Dosegljivo na: http:// www.emedicine.com/med/topics3125.htm, April, 13, 2006.
Trenque T, Frances C, Millart H, Hoizey G, Germain ML. Prevalence of factitious hypoglycaemia associated with sulphonylurea drugs in France in the year 2000. British Journal of Clinical Pharmacology 2002; 54: 548.
Kwong PYP, Teale JD. Screening for sulphonylureas in the investigation of hypoglycaemia. JR Soc Med 2002; 95: 381–5.
Koselj M. Fakticijska hipoglikemija. Endocrin Iugoslav 1984; 7: 85–90.
Bhatnagar D. Diagnosis of factitious hypoglycaemia. Brit J Hosp Med 1988; 40: 140–2.
Given BD, Ostrega DM, Polonsky KS, Baldwin D, Kelley RI, Rubenstein AH. Hypoglycaemia due to surreptitious injection of insulin – identification of insulin species by high-performance liquid chromatography. Diabetes Care 1991; 14: 544–7.
Klonoff DC, Barrett BJ, Nolte MS, Cohen RM, Wyderski R. Hypoglycaemia following inadvertent and factitious sulfonylurea overdosages. Diabetes Care 1995; 18: 563–7.
Sener A, Gillet C, Verhelst J, DeBoeck K, Mahler C, Malaisse WJ. Factitious hypoglycaemia documented by a modified assay for the measurement of plasma sulphonylurea. Diabet Med 1995; 12: 433–5.
Giurgea I, Ulinski T, Touati G, Sempoux C, Mochel F, Brunelle F, et al. Factitious hyperinsulinism leading to pancreatectomy: severe forms of Munchausen syndrome by proxy. Pediatrics 2005; 116: 145–8.
Hirshberg B, Skarulis MC, Pucino F, Csako G, Brennan R, Gorden P. Repaglinide-induced factitious hypoglycaemia. J Clin Endocrinol Met 2001; 86: 475–7.
Bretz SW, Richards JR. Munchausen Syndrome presenting acutely in the emergency department. J Emerg Med 2000; 18: 417– 20.
Asher R. Munchausen syndrome. Lancet 1951; 1: 339–41.
Marks V. Hypoglycaemia – real and unreal, lawful and unlawful: the 1994 Banting lecture. Diabet Med 1995; 12: 850–64.
Owen L, Ellis M, Shield J. Deliberate sulphonylurea poisoning mimicking hyperinsulinaemia of infancy. Arch Dis Child 2000; 82: 392–3.
Downloads
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Slovenian Medical Association) has the right to transfer the rights of acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
