Importance of Insulin Immunoassays in the Diagnosis of Factitious Hypoglycemia
JOURNAL OF CLINICAL RESEARCH IN PEDIATRIC ENDOCRINOLOGY, vol.6, no.4, pp.258-261, 2014 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 6 Issue: 4
- Publication Date: 2014
- Doi Number: 10.4274/jcrpe.1492
- Journal Name: JOURNAL OF CLINICAL RESEARCH IN PEDIATRIC ENDOCRINOLOGY
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Page Numbers: pp.258-261
- Keywords: Type 1 diabetes mellitus, DIDMOAD, factitious hypoglycemia, recurrent hypoglycemia, insulin assay, CROSS-REACTIVITY, ANALOGS, MISUSE
- Istanbul University Affiliated: No
Abstract
We report two cases emphasizing the importance of insulin assays for evaluation of hypoglycemia in diabetic patients. Case 1 was a 9(6/12)-year-old female patient with type 1 diabetes mellitus and case 2 was a 10(10/12)-year-old male patient with DIDMOAD. Both patients were on a basal-bolus insulin regimen. Both were admitted because of persistent hypoglycemia. Analyses of serum samples obtained at the time of hypoglycemia initially showed low insulin and C-peptide levels. Recurrent episodes of unexplained hypoglycemia necessitated measurement of insulin levels by using different insulin assays, which revealed hyperinsulinemic hypoglycemia with low C-peptide levels, findings which confirmed a diagnosis of factitious hypoglycemia. Surreptitious administration of insulin should not be excluded in diabetic patients with hypoglycemia without taking into account the rate of cross-reactivity of insulin analogues with the insulin assay used.