A case report of type 1 diabetes mellitus and factitious hypoglycemia in a patient with Munchausen Syndrome

Abstract

Munchausen syndrome is rarely considered as a first diagnosis, especially in a type 1 diabetic patient presenting with hyperinsulinemic hypoglycemia. The diagnosis should be considered when episodes of hypoglycemia are persistent, and tests suggest a possible exogenous source of insulin. We report a case of a 26-year-old man with multiple hypoglycemic episodes and a long known diagnosis of diabetes type 1 who was referred to our institution after multiple in and out patient consultations in other institutions. He arrived with persistent hypoglycemia, even after withdrawal of insulin therapy on medical record, but persistent self-administration and misuse, without health care professional knowledge, of insulin therapy. He was diagnosed with factitious hypoglycemia after psychiatric evaluation. The patient improved with psychotherapy and family support as well as strict vigilance of insulin administration.

Insulin as a Tool in Factitious Dysglycemia

“…Patients without DM are keen to hide their puncture sites, syringes, and their insulin even during an exhaustive search, which may raise some ethical complaints on some occasions even with their consent [ 1 ]. That was the condition in the first described case.…”

“…Factitious dysglycemia includes an attempt to induce either hypo- or hyperglycemia by manipulating the dose of insulin or insulin secretagogues to cause sickness [ 1 , 2 ]. This problem is challenging to identify because most clinicians do not imagine that their patients would deliberately exacerbate their illness [ 3 ].…”