Insulin as a Tool in Factitious Dysglycemia

Area of Science:

• Endocrinology
• Psychiatry
• Medical Case Studies

Background:

• Factitious dysglycemia involves intentional self-harm to induce abnormal blood glucose levels (hypoglycemia or hyperglycemia) for psychological gain, often seeking attention or empathy.
• This behavior is a form of self-inflicted harm, presenting complex diagnostic and management challenges in clinical practice.

Observation:

• This case series details three Iraqi women presenting with factitious dysglycemia.
• Two women intentionally induced hypoglycemia using insulin to regain family affection.
• A third woman with type 1 diabetes mellitus deliberately omitted insulin, leading to diabetic ketoacidosis and repeated hospitalizations for familial attention, with underlying suicidal ideation.

Findings:

• Thorough patient history, physical examination, and family involvement were crucial in uncovering the underlying factitious behavior.
• The diverse motivations behind factitious dysglycemia, including seeking affection and attention through illness, were identified.

Implications:

• These cases underscore the importance of considering factitious disorders in patients with unexplained glycemic abnormalities.
• Prompt psychiatric referral and management are essential for addressing the psychological underpinnings of factitious dysglycemia.
• This series represents the first documented cases of factitious dysglycemia from Iraq, contributing to a broader understanding of the condition in diverse cultural contexts.