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Iatrogenic or Factitious Hypoglycaemia

المؤلف:  Wass, J. A. H., Arlt, W., & Semple, R. K. (Eds.).

المصدر:  Oxford Textbook of Endocrinology and Diabetes

الجزء والصفحة:  3rd edition , p1012-1013

2026-08-29

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Hypoglycaemia is a well- recognized side effect of insulin treatment and may account for 4% of deaths in patients with type 1 diabetes as they are vulnerable due to hypoglycaemic unawareness and impaired catecholamine responses. With the advent of insulin pump therapy, the frequency of severe hypoglycaemia in type 1 diabetes was shown to be markedly reduced (for continuous subcutaneous insulin infusion versus multidose insulin injections, a mean 2.9- fold reduction for randomized controlled trials, 4.3- fold for before/ after studies, and 4.2- fold for all studies) despite superior glycaemic control. Examples of insulin secretagogues include sulphonylureas and meglitinides, but these have become less popular in the treatment of type 2 diabetes considering the availability of other newer agents that are less likely to cause hypoglycaemia. Elderly patients with cognitive or renal impairment and those using multiple or more potent agents are more prone to hypoglycaemia.

Factitious hypoglycaemia in diabetic patients can be secondary to accidental overdose or inappropriate self- manipulation of these medications. As for non- diabetic individuals, unexpected administration of hypoglycaemic agents as in dispensing errors, and in situations where these drugs are easily accessible, surreptitious, or even malicious, hypoglycaemia may not be evident upon initial evaluation. Meticulous history taking together with thorough review of drug records is thus essential. Patients receiving insulin injections typically have very high blood insulin but low C- peptide levels. However, the biochemical pictures in the use of oral hypo glycaemic agents and insulinoma are similar: elevated blood insulin and C- peptide levels. Demonstration of detectable sulphonylurea level in the serum and/ or urine is therefore a crucial clue in such a scenario, assuming the relevant agent can be assayed.