Factitious Hypoglycemia


May 08, 2002

In This Article


Factitious disorders are self-induced symptoms or diseases. One of the best characterized of these is factitious hypoglycemia. It may occur in both the fasting and postprandial states. Early diagnosis of factitious hypoglycemia is extremely important because of its potential to be fatal. Often, the diagnosis is made when the physician is attempting to rule out an insulinoma. Once the diagnosis of drug-induced hyperinsulinemic hypoglycemia is confirmed, the next step is to determine whether the hyperinsulinism is due to exogenous administration of insulin or sulfonylureas. In the past, the diagnosis of drug-induced hypoglycemia relied upon circumstantial evidence. However, the development of a radioimmunoassay for human peptide-C, a marker for endogenous insulin secretion, proves to be useful in differentiating an insulinoma from insulin-induced hypoglycemia. Diagnosis of sulfonylurea-induced hypoglycemia requires the measurement of the drug in the serum or urine. Treatment of factitious hypoglycemia occurs in 2 stages. The first stage involves restoring the plasma glucose levels in an attempt to relieve the hypoglycemic symptoms. The second stage is more difficult and requires managing the patient and preventing further hypoglycemic attacks. The purpose of this review article is to increase healthcare professionals' awareness of factitious hypoglycemia.