Factitious Hypoglycemia in Pregnancy in a Patient With Type 2 Diabetes

Guedes, Begoña Vega; Acosta, Concepción Santana; Cabrera, Francisco; Wägner, Ana M.

doi:10.1097/aog.0000000000000138

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…Артифициальный гипогликемический синдром или артифициальная гипогликемия (АрГ) является одним из самых известных «искусственных заболеваний» [2] и представляет собой преднамеренное применение препаратов инсулина или пероральных сахароснижающих препаратов (ПССП) с целью снижения уровня глюкозы крови [3]. Данное состояние описано как у лиц без нарушений углеводного обмена, так и у пациентов с сахарным диабетом (СД) [2,4,5]; нередко встречается у работников в сфере здравоохранения [4], а также у пациентов, родственники которых страдают СД. Часто имеют место коморбидные психиатрические заболевания и социально-психологические проблемы [4,6,7,8].…”

Section: актуальностьunclassified

Diagnosis of artificial hypoglycemia due to oral hypoglycemic drugs by high-performance liquid chromatography with tandem mass spectrometric detection

Yukina,

Troshina,

Nuralieva

et al. 2024

Diabetes mellitus

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BACKGROUND: Artificial hypoglycemia (ArH) is a decrease of blood glucose levels less than 3 mmol/l due to the deliberate use of hypoglycemic drugs by a patient outside of medical appointments. Timely diagnosis of this kind of hypoglycemia avoids unnecessary numerous examinations and hospitalizations. However, the detection of ArH still remains an extremely difficult task for both the healthcare facility and the attending physician. The foreign literature describes cases of successful detection of deliberate intake of oral hypoglycemic drugs (OHD) using high-performance liquid chromatography with tandem mass spectrometric detection (HPLC-MS/MS). Thus, it is relevant to develop and validate a method for determining OHD using HPLC-MS/MS.AIM: To optimize the diagnosis of ArH due to the use of OHD.MATERIALS AND METHODS: A total of 92 patients were examined. The development of the HPLC-MS/MS method for the detection of the studied OHD (sOHD; n=1-glibenclamide, n=1-gliquidone, n=1-gliclazide, n=1-glimepiride, n=1-glipizide, n=1-nateglinide and n=1-repaglinide) in the blood was carried out in a group of patients with diabetes mellitus type 2 (n=7) who received sOHD, and a group of conditionally healthy people who did not receive any medications (n= 7). To validate the method, the determination of sOHD substances was carried out on groups of patients with hyperinsulinemic nondiabetic hypoglycemia (NDH) of unknown origin (n=11) and with insulinoma (n=67).RESULTS: In the study of blood samples by HPLC-MS/MS in the group of patients with diabetes mellitus type 2, was confirmed in 100% of the cases the use of the drug that the patient received, in the group of conditionally healthy — sOHD were not detected. A false positive result was not obtained in any conditionally healthy and in any patient with insulinoma. ArH was diagnosed in 5 out of 11 patients in the group with hyperinsulinemic NDH of unknown origin, the method identified sOHD glibenclamide and gliclazide in the patients’ blood samples. In the remaining 6 patients of this group, examinations were continued and other causes of NDH were diagnosed. The sensitivity of the method was 100% [74%; 100%], specificity — 100% [95%; 100%].CONCLUSION: The HPLC-MS/MS method has high diagnostic accuracy in the detection and identification of sOHD (glibenclamide, gliquidone, gliclazide, glimepiride, glipizide, nateglinide and repaglinide) in blood samples of patients receiving these drugs. Currently, due to the low availability of the method, this study is advisable to use in patients with hyperinsulinemic hypoglycemia with negative results of first-line insulinoma imaging methods (computed tomography with contrast enhancement, ultrasound and magnetic resonance imaging of the abdominal cavity).

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Section: актуальностьunclassified

Diagnosis of artificial hypoglycemia due to oral hypoglycemic drugs by high-performance liquid chromatography with tandem mass spectrometric detection

Yukina,

Troshina,

Nuralieva

et al. 2024

Diabetes mellitus

View full text Add to dashboard Cite

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“…1 This condition has been described in patients without disorders of carbohydrate metabolism and in patients with diabetes mellitus (DM) as well. [2][3][4] Patients may often present with psychiatric diseases and psychosocial problems. 2,5,6 Moreover, surreptitious hypoglycemia is common in relatives of patients with DM.…”

Section: Introductionmentioning

confidence: 99%

Clinical Case of Surreptitious Hypoglycemia Due to Deliberate Insulin Analog Administration

Yukina

Nuralieva

Трошина

et al. 2021

Clin Med Insights Case Rep

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Hypoglycemic syndrome is a life-threatening condition that can lead to hypoglycemic coma and death. Surreptitious hypoglycemic syndrome is the deliberate use of insulin preparations or oral hypoglycemic drugs aimed to reduce blood glucose level. If human insulin is injected, high level of immunoreactive insulin (IRI) and low level of C-peptide at the moment of hypoglycemia are always detected. However, the fact of deliberate administration of insulin analogs is difficult to prove. In these cases if insulin kit test with low cross-reactivity with insulin analogs is used, the low levels of IRI and C-peptide will be suspected. Some experts suggest the presence of cross reactivity with analogs of insulin in a number of commercial kits, which makes it possible to detect cases of surreptitious hypoglycemia. We present a clinical case of a patient with surreptitious hypoglycemia due to the administration of insulin analogs and discuss the problems of its laboratory diagnosis.

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Made up by makeup—A case report about an exceptional kind of self-inflicted “injuries”

Mauf

Martinez

Thali

et al. 2015

Forensic Science International

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Factitious Hypoglycemia in Pregnancy in a Patient With Type 2 Diabetes

Abstract: Factitious hypoglycemia should be considered as part of the differential diagnosis of unexplained hypoglycemia. Blood sampling during an episode of hypoglycemia is pivotal in this assessment.

Cited by 4 publications

References 7 publications

Diagnosis of artificial hypoglycemia due to oral hypoglycemic drugs by high-performance liquid chromatography with tandem mass spectrometric detection

Diagnosis of artificial hypoglycemia due to oral hypoglycemic drugs by high-performance liquid chromatography with tandem mass spectrometric detection

Clinical Case of Surreptitious Hypoglycemia Due to Deliberate Insulin Analog Administration

Made up by makeup—A case report about an exceptional kind of self-inflicted “injuries”

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