Factitious hypoglycemia in insulin-treated diabetic patients |
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| Affiliation: | 1. Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France;2. Department of Nuclear Medicine, Montpellier Cancer Institute (ICM), Montpellier, France;3. Laboratory of Biochemistry and Hormonology, Montpellier University Hospital, Montpellier, France;4. PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France;5. INSERM 1411 Clinical Investigation Centre, Montpellier, France;6. Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France;1. Department of Neuro-Ophthalmology, Hôpital Pierre-Wertheimer, Hospices Civils de Lyon, 69500 Bron, France;2. Department of Endocrinology, Hôpital Louis-Pradel, Hospices Civils de Lyon, 69500 Bron, France;3. Department of Radiology, Hôpital Pierre-Wertheimer, Hospices Civils de Lyon, 69500 Bron, France;4. Claude-Bernard Lyon I University, Bron, France;5. Department of Neurosurgery B, Hôpital Pierre-Wertheimer, Hospices Civils de Lyon, 69500 Bron, France;6. Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR5292, IMPACT Team, Bron, France;1. Service d’endocrinologie, diabète, CHU de Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34090 Montpellier, France;2. Service d’endocrinologie, diabétologie, nutrition, Hôpital Nord, Centre Hospitalo-Universitaire-Université Picardie Jules Vernes d’Amiens, 2, Place Victor Pauchet, 80080 Amiens, France;3. Assistance Publique-Hôpitaux de Marseille (AP-HM), service d’endocrinologie, hôpital de la Conception, Centre de Référence des Maladies Rares de l’hypophyse HYPO, 147, Boulevard Baille, 13005 Marseille, France;4. 2 Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France;1. Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance publique Hôpitaux de Paris, Antoine Beclere Hospital, 92140, Clamart, France;2. Université Paris Saclay, Inserm, physiologie et physiopathologie endocrinienne, 94276, Le Kremlin-Bicêtre, France;1. Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, Liège, Belgium;2. Division of Clinical Pharmacology, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium |
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| Abstract: | Factitious hypoglycemia is a factitious disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), referring to intentionally covertly induced hypoglycemia, with potentially severe consequences. Knowledge of factitious hypoglycemia relies on case reports, and evidence-based information and guidelines are lacking. Diagnosing factitious hypoglycemia in insulin-treated diabetic persons is therefore challenging and often requires a long and costly process. Moreover, the typical metrics proposed to differentiate insulin-induced factitious hypoglycemia from insulinoma (i.e., high insulin and low C-peptide versus high insulin and high C-peptide, respectively) are not always applicable, depending on whether the insulin quantification method can detect the insulin analog. When factitious hypoglycemia is suspected, an emerging trend from recent publications advocates a combination of two insulin quantification methods with different cross-reactivity for insulin analogs, early on in the diagnostic process. |
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| Keywords: | Factitious disorder Hypoglycemia Munchausen syndrome Insulin quantification immunoassay C-peptide Diabetes |
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