- F John Service, MD, PhD
F John Service, MD, PhD
- Emeritus Professor of Medicine
- Mayo Clinic College of Medicine
- Adrian Vella, MD
Adrian Vella, MD
- Professor of Medicine
- Mayo Clinic
Factitious (or factitial) hypoglycemia occurs secondary to the surreptitious use of insulin or insulin secretagogues (sulfonylureas, meglitinides). The term factitious (or factitial) hypoglycemia has been used in medical parlance to imply covert human activity. The consideration of such a possibility often changes the patient-clinician relationship, leading the clinician to feel deceived and the patient to feel mistrusted. However, the pejorative connotation with which factitious illness has been encumbered requires softening because some patients with factitious disease suffer through no fault of their own.
The clinical features, diagnosis, and treatment of factitious hypoglycemia will be reviewed here. Other causes of hypoglycemia are discussed elsewhere. (See "Hypoglycemia in adults: Clinical manifestations, definition, and causes" and "Insulinoma".)
ETIOLOGY OF FACTITIOUS HYPOGLYCEMIA
Factitious hypoglycemia results from the use of insulin or insulin secretagogues (sulfonylurea, meglitinides) but not from metformin or other insulin-sensitizing antidiabetic drugs [1-3].
Ingestion of an oral insulin secretagogue — The first reported case of factitious hypoglycemia related to a sulfonylurea was due to the surreptitious self-administration of chlorpropamide by a patient without diabetes . Inappropriate manipulation of hypoglycemic tablets by a patient with diabetes is another cause of factitious hypoglycemia.
In addition to patients who knowingly take insulin secretagogue drugs, there are patients who, by taking a prescribed medication in good faith, have hypoglycemia because a sulfonylurea was mistakenly dispensed . In most instances, confusion in dispensing the drug arose because of similarity in spelling between the intended medication and the sulfonylurea. The most common errors in early reports were the substitutions of Diabinese for Diamox [6,7] and of Tolinase for Tolectin .
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- Waickus CM, de Bustros A, Shakil A. Recognizing factitious hypoglycemia in the family practice setting. J Am Board Fam Pract 1999; 12:133.
- DUNCAN GG, JENSON W, EBERLY RJ. Factitious hypoglycemia due to chlorpropamide. Report of a case, with clinical similarity to an islet cell tumor of the pancreas. JAMA 1961; 175:904.
- Klonoff DC, Barrett BJ, Nolte MS, et al. Hypoglycemia following inadvertent and factitious sulfonylurea overdosages. Diabetes Care 1995; 18:563.
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- Hooper PL, Tello RJ, Burstein PJ, Abrams RS. Pseudoinsulinoma--the Diamox-Diabinese switch. N Engl J Med 1990; 323:488.
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- Kaminer Y, Robbins DR. Insulin misuse: a review of an overlooked psychiatric problem. Psychosomatics 1989; 30:19.
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- Murray BJ. Hypoglycemia secondary to factitious hyperinsulinism. Postgrad Med 1981; 69:237, 240.
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- Fasano CJ, O'Malley G, Dominici P, et al. Comparison of octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400.
- ETIOLOGY OF FACTITIOUS HYPOGLYCEMIA
- Ingestion of an oral insulin secretagogue
- Administration of insulin
- CLINICAL CHARACTERISTICS
- Laboratory tests
- Interpretation of tests
- - Insulin secretagogues
- - Exogenous insulin
- Insulin measurements
- Insulin secretagogue measurements
- C-peptide measurements
- Anti-insulin antibodies
- Long term
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Laboratory testing
- Interpretation of laboratory results
- Patients with preexisting diabetes