Factitious hyperinsulinemic hypoglycemia: confirmation of the diagnosis by a species-specific insulin radioimmunoassay

Walfish, Paul G.; Feig, Denice S.; Bauman, William A.

doi:10.1007/bf03347007

Cited by 10 publications

(2 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The knowledge of possible fatal complications of insulin overdosages occasionally leads to incidents when insulin is used as a weapon either against oneself (suicide or factitious hypoglycemia), against a dependent (Munchausen by proxy), or against another person (homicide) [16]. Arem [17] found 81 cases of factitious hypoinsulinemia in the world literature written until 1985, and more suicides committed by insulin application are documented [18][19][20][21][22][23][24][25][26][27]. After human insulin was replaced by synthetic insulin, rapid-acting as well as long-acting insulin formulations (57.8% vs. 42.8%) [28,29] were used.…”

Section: Hypoglycemiamentioning

confidence: 99%

Disorders of glucose metabolism–post mortem analyses in forensic cases: part I

2010

View full text Add to dashboard Cite

In developed countries, diabetes is one of the ten most common causes of death. Post mortem diagnosis of glucose metabolism disorders can be difficult and vague because of the lack of characteristic morphological findings. Reviews of the literature are presented concerning biochemical problems in cases of unclear hyper- or hypoglycemia. After repetition of causes, frequency, and mortality of diabetic metabolism disorders, we give hints for the detection of diabetic ketoacidosis, hyperosmolar coma, insulinoma, and insulin- or oral diabetic-induced hypoglycemia. The first part discusses the analytes glucose and lactate, glycated proteins and oral antidiabetics, with special regard to their matrices post mortem, to reference concentrations, stability data and to analytic procedures that should be used in clinical or toxicological laboratories to detect diabetic metabolism disorders after death.

show abstract

Section: Hypoglycemiamentioning

confidence: 99%

Disorders of glucose metabolism–post mortem analyses in forensic cases: part I

2010

View full text Add to dashboard Cite

show abstract

“…With the development of insulin analogs, one important caveat is that insulin concentrations may be falsely low depending on the cross-reactivity with the particular assay used. Specific assays now detect a variety of insulins including human insulin, animal insulin, and insulin analogs (Andersen, Jorgensen, Jensen et al, 2000, Bowsher, Lynch, Brown-Augsburger et al, 1999, Moriyama, Hayashi, Ohyabu et al, 2006, Neal, 2008, Walfish, Feig and Bauman, 1987). Urinary liquid chromatography/tandem mass spectroscopy has also been proposed to detect insulin analogs (Holt and Sonksen, 2008).…”

Section: Methods Of Detectionmentioning

confidence: 99%

Use of growth hormone, IGF-I, and insulin for anabolic purpose: Pharmacological basis, methods of detection, and adverse effects

Anderson

Tamayose

García

2018

Molecular and Cellular Endocrinology

View full text Add to dashboard Cite

Hormones with anabolic properties such as growth hormone (GH), insulin-like growth factor-1 (IGF-I), and insulin are commonly abused among professional and recreational athletes to enhance physical ability. Performance enhancing drugs (PEDs) such as these are also commonly used by recreational athletes to improve body aesthetics. The perception of increased muscle mass due to supraphysiologic hormone supplementation, or doping, is widespread among PED users despite a paucity of evidence-based data in humans. Even still, athletes will continue to abuse PEDs in hopes of replicating anecdotal results. It is important to educate the general public and potential treating physicians of the risks of PED use, including the dangers of polypharmacy and substance dependence. It will also be important for the research community to address the common challenges associated with studying PED use such as the ethical considerations of PED administration, the general reticence of the PED-using community to volunteer information, and the constant need to improve or create new detection methods as athletes continually attempt to circumvent current methods. This review highlights the anabolic mechanisms and suggestive data implicating GH, IGF-I, and insulin for use as PEDs, the specific detection methods with cutoff ranges that may be utilized to diagnose abuse of each substance, and their respective side effects.

show abstract

The Molar Ratio of Insulin to C-Peptide

Lebowitz¹

1993

Arch Intern Med

View full text Add to dashboard Cite

After beta-cell stimulation by carbohydrate or other secretagogues, insulin and C-peptide are secreted into the portal vein in a 1:1 molar ratio. A large fraction of endogenous insulin is cleared by the liver, whereas C-peptide, which is cleared primarily by the kidney and has a lower metabolic clearance rate than insulin, traverses the liver with essentially no extraction by hepatocytes. Hence, the molar ratio of insulin to C-peptide in peripheral venous blood (ICPR) should be less than 1.0 during fasting and feeding, unless exogenous insulin is introduced into the systemic circulation. Consequently, an ICPR in excess of 1.0 in a hypoglycemic patient argues persuasively for surreptitious or inadvertent insulin administration and against insulinoma (or sulfonylurea ingestion) as the cause of the hypoglycemia. This conclusion is supported by personal experience and by the literature.

show abstract

Factitious hyperinsulinemic hypoglycemia: confirmation of the diagnosis by a species-specific insulin radioimmunoassay

Cited by 10 publications

References 7 publications

Disorders of glucose metabolism–post mortem analyses in forensic cases: part I

Disorders of glucose metabolism–post mortem analyses in forensic cases: part I

Use of growth hormone, IGF-I, and insulin for anabolic purpose: Pharmacological basis, methods of detection, and adverse effects

The Molar Ratio of Insulin to C-Peptide

Contact Info

Product

Resources

About