Factitious Hypoglycemia

Disclosures

May 08, 2002

In This Article

Treatment of Factitious Hypoglycemia

Treatment of factitious hypoglycemia, whether it is insulin- or sulfonylurea-induced, takes place in 2 stages.[3] The first stage involves relieving the neuroglycopenic symptoms by restoring the low plasma glucose to within the normal range.[10] The second stage involves correcting the underlying cause of the hypoglycemia.

If the patient is unconscious, the initial stage involves immediate return of the patient's blood glucose to normal or slightly above normal (5 to 10 mmol/L).[3] However, it is important to ensure that the glucose levels remain stable by intravenous infusion of glucose until all of the causative drug has been absorbed and degraded metabolically. Typically, this requires a minimum of 36 hours.[23] Continuous monitoring is necessary to determine how much glucose should be administered.

Treatment of sulfonylurea-induced hypoglycemia with intravenous glucose does not correct the hyperinsulinemia.[27] In these patients, a hypertonic glucose bolus may aggravate the situation by exposing the patient to the sudden hyperglycemia. This may further stimulate the sulfonylurea-primed pancreas to release more insulin.[27]

Drugs that block the release of insulin may be required in patients with sulfonylurea-induced hypoglycemia if it is difficult to maintain blood glucose levels by intravenous glucose alone.[23] These drugs include diazoxide, a specific antidote to sulfonylurea-induced hypoglycemia,[23] and octreotide, a semisynthetic long-acting analog of somatostatin.[28] Diazoxide, an antihypertensive drug, has potent hyperglycemic action when it is administered orally.[21] Diazoxide antagonizes the hypoglycemic effect of sulfonylureas by specifically inhibiting the release of insulin from the beta cells.[28] Intravenous administration of octreotide is capable of inhibiting glucose-stimulated beta cells.[29]

Additional treatment is recommended to counteract hypoglycemic coma.[23] Intravenous hydrocortisone should be administered immediately once therapy is started.[3] If the patient does not regain consciousness within 15 to 20 minutes after restoration of normoglycemia, then intravenous dexamethasone and mannitol should be administered.[23]

The second stage, the more difficult stage, requires managing the patient and preventing further hypoglycemia attacks.[3] The medical literature cites numerous reports of patients who not only deny their illness but who are unwilling to undergo psychiatric treatment.[3] The patient's acknowledgment of the diagnosis does not guarantee that the patient will deal with the problem.[30]

The medical literature poorly describes the long-term treatment of patients with factitious hypoglycemia and its outcomes.[3] One study followed 10 patients with insulin-induced factitious hypoglycemia for several years.[30] Three patients returned to good health, 2 patients committed suicide, 4 patients continued to experience medical problems, and 1 patient was lost to follow-up. The researchers concluded that the long-term outcome for these patients is unpredictable.[30]

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