Severe hypoglycemias in a diabetic man by surreptitious self-injections of an insulin analogue

A 44 years-old diabetic male patient was admitted several times to the emergency department of Albi Hospital (France) for nocturnal hypoglycemias with losses of consciousness. The initial blood analysis, performed on a Cobas(?) analyzer, retrieved low levels of insulinemia. This patient was treated by analogues of insulin and did not present any comorbidities. Moreover, an extensive check-up did not retrieve any evident cause for these hypoglycemias. After a severe hypoglycemic coma that occurred during the last hospitalization when insulinotherapy was interrupted, the staff suggested the possibility of a factice hypoglycemia by surreptitious administration of insulin. Hormonal assays were then performed on a Centaur(?) analyzer, which is able to recognize insulin aspart and glargine. They revealed elevated concentrations of insulin along with low levels of C-peptide. Such a blood profile is consistent with an exogenous administration of insulin or its analogues. On the basis of this biological clue, the patient was questioned again and he finally admitted self-injection of insulin aspart. This case gives us the opportunity to review the diabetic hypoglycemia, to point out the particularities of the blood assays of insulin analogues and to confirm the need of a close collaboration between clinic and laboratory staffs in the difficult cases of factice hypoglycemias.