Ellen L. Toth, MD
To the Editor: Factitious hypoglycemia due to self-induction with insulin (1) is not an uncommon form of the Munchausen syndrome (2). It is recommended that patients with this diagnosis be confronted; however, in the following case, confrontation was initially unrewarding.
An obese female was hospitalized with hypoglycemia disproportionate to the insulin dose she stated she had taken for pre-existing insulin-requiring type II diabetes (random C-peptide, 3.7 µG/L). During hypoglycemia suppressed C-peptide levels (< 0.3 µG/L) with high total insulin values (> 240 µmol/L) were found, suggesting insulin abuse (1). On confrontation she vehemently denied this and discharged herself.
Toth EL. Factitious Hypoglycemia and the Multiple Personality Disorder. Ann Intern Med. ;112:76. doi: 10.7326/0003-4819-112-1-76_1
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Published: Ann Intern Med. 1990;112(1):76.
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