Factitious Hypoglycaemia: A Case Report and Literature Review

Factitious hypoglycaemia is a form of factitious disorder imposed on self with high morbidity and mortality. It is therefore important to be aware of the key demographic and contextual risk factors for factitious hypoglycaemia, as well the investigations and management options available for suspected cases.

In this article we describe a case report and literature review of factitious hypoglycaemia. The search was conducted using the PubMed database and identified 23 case reports of 31 patients aged 18 or over with insulin-induced factitious hypoglycaemia.

The average age of these patients was 33.7 (±13.5) years, the female: male ratio was 4.3:1, 38% had medical occupations or past medical training, 53% had diabetes mellitus, and 41% had a positive psychiatric history. Misdiagnoses were common and often resulted in inappropriate treatment. Very few cases discussed psychiatric management.

Factitious hypoglycaemia is more commonly reported in middle-aged females, in a medical profession, with a past medical history of diabetes mellitus and psychiatric illness. However, it may affect a variety of patients and the absence of these features should not discourage a diagnosis. C-peptide levels and insulin assays can help identify factitious hypoglycaemia over other causes of hypoglycaemia, and management should include a greater focus on psychiatric treatment.