Lesson of the week: Insulin as a substance of misuse in a patient with insulin dependent diabetes mellitus

Abstract

Doctors should be alert to the possibility of insulin misuse, and should consider psychological evaluation, in an insulin dependent diabetic patient with poor control

Importance of Insulin Immunoassays in the Diagnosis of Factitious Hypoglycemia

“…Insulin was misused by patients for purposes such as catching attention or skipping school ( 11 , 12 ). Reaching a state of hypoglycemia to be able to eat sugar-containing foods or a state of euphoria due to hypoglycemia were other cited reasons ( 11 , 12 , 13 , 14 ). Insulin has also been used to commit suicide ( 13 , 14 , 15 , 16 ).…”

The Interface of Child Mental Health and Juvenile Diabetes Mellitus

“…In addition to other means, insulin is a potential means for self-injury. 48,49 With nearly one-third of diabetic adolescents experiencing comorbid depression and similar numbers reported in the adult population, researchers are looking for links ---of brain pathology/changes caused by the illness leading to increased risk for depression. McEwen and colleagues 50 propose that the progressive atrophy of the hippocampus is seen in animals with diabetes, which is similar to changes seen in depression.…”

Factitious hypoglycemia in children and adolescents with diabetes

“…One 15‐year‐old boy described the rapid onset of hypoglycemia as exciting and associated with euphoria . In adults, these exhilarating feelings have also been reported when insulin is administered together with illicit drugs and alcohol . Depression appears to be an important contributing factor.…”

“…27 In adults, these exhilarating feelings have also been reported when insulin is administered together with illicit drugs and alcohol. 42 Depression appears to be an important contributing factor. In youth with type 1 diabetes, its prevalence has been found as high as 1 in 7 youths, which is at least twice as high as in youths in general.…”