Hypoglycemia factitia: Munchhausen syndrome in diabetes mellitus

The medical history of a 43-year-old non-insulin-dependent diabetic patient with severe and repetitive hypoglycemic episodes is reported. The exact diagnosis proved to be difficult. Finally, surreptitious insulin administration was documented by high serum insulin and low C-peptide values with an elevated molar ratio of insulin to C-peptide in peripheral venous blood during hypoglycemia. Confronting the patient with evidences of surreptitious insulin administration, hypoglycemic episodes abruptly stopped. Hypoglycemia factitia was assessed as a manifestation of Munchhausen syndrome in diabetes mellitus.