RT Journal Article
SR Electronic
T1 Recognizing Factitious Hypoglycemia in the Family Practice Setting
JF The Journal of the American Board of Family
                Practice
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 133
OP 136
DO 10.3122/jabfm.12.2.133
VO 12
IS 2
A1 Cynthia M. Waickus
A1 Andrée de Bustros
A1 Amer Shakil
YR 1999
UL http://www.jabfm.org/content/12/2/133.abstract
AB 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.