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Factitious hypoglycemia

F John Service, MD, PhD
Adrian Vella, MD
Section Editor
Irl B Hirsch, MD
Deputy Editor
Jean E Mulder, MD


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".)


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 [4]. 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 [5]. 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 [8].

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Literature review current through: Nov 2017. | This topic last updated: Oct 20, 2016.
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