A clinical case of factitious hypoglycemia in a patient with type 1 diabetes mellitus

Artificial hypoglycemia (Munchausen syndrome) is a condition caused by low blood glucose due to the deliberate taking of insulin or oral hypoglycemic drugs. Artificial hypoglycemia remains one of the problems that endocrinologists face in their practice; a diagnostic search for its etiological factor can lead to expensive and unnecessary studies. Diagnosis of artificial hypoglycemia in patients with diabetes mellitus on insulin therapy seems to be a labor-intensive task, since unlike most factitious disorders, which may be indicated by atypical manifestations of the disease or conflicting medical information about the patient, in patients with diabetes mellitus hypoglycemic syndrome is an expected unwanted event due to insulin therapy. Therefore, deliberate insulin administration is often not diagnosed until self-induced hypoglycemia becomes recurrent and/or severe. If artificial hypoglycemia is suspected, a number of authors currently recommend testing С peptide and a combination of two methods for quantitative determination of insulin in the blood using different analyzer systems. Active collaboration between clinical and laboratory specialists is the key to successfully solving such a diagnostic problem. This article presents a clinical case of Munchausen syndrome in a 28-year-old patient with type 1 diabetes mellitus with recurrent hypoglycemia during 21 years, repeated severe hypoglycemia, including loss of consciousness, and proven intentional administration of an insulin analog drug during hospital stay; the complex diagnostic path passed before making the correct diagnosis is described.