Factitial Hypoglycemia

Factitial hypoglycemia occurs as a result of the inappropriate use of a hypoglycemic agent, either through surreptitious self-administration, malicious administration to others, or innocent compliance with a prescription wrongly dispensed. The most common form of factitial hypoglycemia is the covert self-administration of a hypoglycemic agent by a patient without diabetes. A close second is the inappropriate manipulation of doses of hypoglycemic agents by patients with diabetes. These patients are commonly women in the third and fourth decades of life and, among non-diabetic persons, are likely to have health' related occupations. Diagnosis in persons without diabetes requires simultaneous determination of plasma glucose, insulin, C-peptide, and sulfonylurea during an episode of hypoglycemia. Sulfonylurea factitial hypoglycemia is characterized by non-suppressed levels of plasma insulin and C-peptide and the presence of sulfonylurea in urine or blood. Insulin factitial hypoglycemia is characterized by non- he suppressed levels of insulin, suppressed levels of C-peptide, and the absence of sulfonylurea. Assessment of factitial hypoglycemia in a person with diabetes requires close observation under controlled conditions.