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Research ArticleMedical Practice

Recognizing Factitious Hypoglycemia in the Family Practice Setting

Cynthia M. Waickus, Andrée de Bustros and Amer Shakil
The Journal of the American Board of Family Practice March 1999, 12 (2) 133-136; DOI: https://doi.org/10.3122/jabfm.12.2.133
Cynthia M. Waickus
From the Department of Family Medicine (CMW),Rush-Presbyterian-St. Luke's Medical Center, Chicago, the Department of Internal Medicine (AB), Christ Hospital and Medical Center, Oak Lawn, and the UIC-Christ Family Practice Residency Program (AS), Christ Hospital/University of Illinois at Chicago, Oak Lawn, Ill. Address reprint requests to Cynthia M. Waickus, MD, PhD, Department of Family Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612
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Andrée de Bustros
From the Department of Family Medicine (CMW),Rush-Presbyterian-St. Luke's Medical Center, Chicago, the Department of Internal Medicine (AB), Christ Hospital and Medical Center, Oak Lawn, and the UIC-Christ Family Practice Residency Program (AS), Christ Hospital/University of Illinois at Chicago, Oak Lawn, Ill. Address reprint requests to Cynthia M. Waickus, MD, PhD, Department of Family Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612
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Amer Shakil
From the Department of Family Medicine (CMW),Rush-Presbyterian-St. Luke's Medical Center, Chicago, the Department of Internal Medicine (AB), Christ Hospital and Medical Center, Oak Lawn, and the UIC-Christ Family Practice Residency Program (AS), Christ Hospital/University of Illinois at Chicago, Oak Lawn, Ill. Address reprint requests to Cynthia M. Waickus, MD, PhD, Department of Family Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612
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Abstract

Background: Factitious hypoglycemia is a deliberate attempt to induce a low serum glucose level using either insulin or oral hypoglycemic agents. Sulfonylurea-induced hypoglycemia is more common than incidents of insulin abuse, and hypoglycemia caused by these oral agents is biochemicallyindistinguishable from insulinoma.

Methods: We describe a case of factitious hypoglycemia resulting from insulin abuse in an adult diabetic patient, review the essentials of glucose homeostasis, and describe diagnostic tests that allow a differential diagnosis.

Results and Conclusion: Factitious hypoglycemia is associated with a higher incidence of suicide, depression, and personality disorders. Insulin-induced hypoglycemia can be detected by an insulin to C-peptide ratio that is greater than 1.0. In the absence of proof to the contrary, insulinoma should be considered the cause of hypoglycemia until another diagnosis is established. The generally poor prognosis for patients with factitious hypoglycemia underscores the importance of early recognition of factitious disorders.

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The Journal of the American Board of Family     Practice: 12 (2)
The Journal of the American Board of Family Practice
Vol. 12, Issue 2
1 Mar 1999
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Recognizing Factitious Hypoglycemia in the Family Practice Setting
Cynthia M. Waickus, Andrée de Bustros, Amer Shakil
The Journal of the American Board of Family Practice Mar 1999, 12 (2) 133-136; DOI: 10.3122/jabfm.12.2.133

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Recognizing Factitious Hypoglycemia in the Family Practice Setting
Cynthia M. Waickus, Andrée de Bustros, Amer Shakil
The Journal of the American Board of Family Practice Mar 1999, 12 (2) 133-136; DOI: 10.3122/jabfm.12.2.133
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