What is Factitious Hypoglycemia?
Factitious hypoglycemia is when someone purposely tries to lower their blood sugar levels. This condition can often pose a challenge for endocrinologists (doctors who specialize in hormonal issues) to diagnose, often leading to expensive and unnecessary tests to rule out other causes of low blood sugar.
When a person injects themselves with insulin, lab tests can show high insulin levels and low levels of a substance called “plasma C-peptide” during an episode of low blood sugar. If a person takes a type of drug known as sulfonylurea, the situation can resemble a rare condition called insulinoma, which is marked by high insulin and C-peptide levels. A drug test can confirm this diagnosis.
What Causes Factitious Hypoglycemia?
Factitious hypoglycemia is a condition where low blood sugar levels are caused by someone injecting themselves with insulin or taking medications that increase insulin production, like sulfonylureas and meglitinides. It’s worth noting that drugs which help the body use insulin more effectively, like metformin, do not cause low blood sugar.
Risk Factors and Frequency for Factitious Hypoglycemia
Factitious hypoglycemia, or low blood sugar that is self-induced, tends to be more prevalent in women who have diabetes. This condition is especially common in those who are in their 30s and 40s.
Signs and Symptoms of Factitious Hypoglycemia
Factitious hypoglycemia is a condition where a person experiences signs of low blood sugar but does not actually have it. People with this condition might experience typical symptoms of low blood sugar such as shaking, sweating, dizziness, irritability, hunger, weakness, confusion, seizures, or even coma. However, if they’ve had repeated episodes of low blood sugar, their symptoms might be less noticeable.
Checking the patient’s medical and personal history is very important when trying to find out if they have factitious hypoglycemia. Specifically, people who work in healthcare, people who live with diabetics, and people with certain mental health conditions like major depression or a history of suicide attempts may be more likely to have this condition. It’s also important to check all the medications the patient is taking, including any herbal supplements, because some could be contaminated with drugs that lower blood sugar. For diabetics, factitious hypoglycemia may be suspected if they still have episodes of low blood sugar even after adjusting their medication dosages.
The signs a doctor would look for during an exam are usually not very specific. The patient might have a fast heart rate and low body temperature, and their skin might be sweaty. In some cases, the doctor might discover signs of insulin injections on the skin, which could suggest factitious hypoglycemia if the patient isn’t prescribed insulin.
Testing for Factitious Hypoglycemia
To diagnose a disorder that’s causing low blood sugar, or hypoglycemia, doctors have to see three things, a trio of signs known as the Whipple triad:
- You show symptoms of hypoglycemia like confusion, sweating, and a rapid heartbeat.
- Your blood glucose levels are low, specifically below 70 mg/dl.
- Your symptoms get better after you’ve had some glucose and your blood sugar levels rise again.
Once these signs are present, and other potential causes have been ruled out, your doctor might order additional lab tests. These could include checking for the levels of plasma insulin, C peptide, proinsulin, and insulin secretagogues in your blood. These tests are usually done when your blood sugar levels drop below 70mg/dl.
Plasma insulin relates to synthetic insulin, which doesn’t contain C-peptide. So, if your hypoglycemia is due to injecting insulin, your plasma insulin levels will be high, but your C peptide and proinsulin levels will be low. This results in the insulin to C peptide ratio being above one.
However, conditions like insulinoma and certain medications like sulfonylureas cause your body to produce more insulin. This leads to a rise in levels of plasma insulin, C peptide, and proinsulin. It’s important to note that these levels may still be within the normal range, but they could be relatively high for someone who is experiencing low blood sugar.
The only way to tell the difference between hypoglycemia caused by an insulinoma or insulin secretagogues is by testing your blood or urine for the presence of the drug, for example, sulfonylureas.
Treatment Options for Factitious Hypoglycemia
The first step in treating fake low blood sugar, also called factitious hypoglycemia, is to bring blood sugar levels back to normal to alleviate symptoms. When the patient is not in the hospital, they can be given oral glucose or injections of a hormone called glucagon. In the hospital, doctors usually give glucose by injection directly into a vein. If the patient is unconscious, they’ll also receive hydrocortisone, a type of medicine that helps regulate blood sugar.
Doctors closely monitor blood sugar levels in these patients and often give them ongoing glucose infusions until the effect of the medication causing the hypoglycemia wears off. This might take one to two days. Giving a large amount of glucose all at once isn’t recommended if the low blood sugar is caused by a type of medication called sulfonylurea, because it can stimulate the body to produce even more insulin.
In cases where the blood sugar levels won’t stabilize even with an IV glucose infusion, additional treatment might be needed. One option is a drug called octreotide, which can stop certain cells in the pancreas from producing insulin. Octreotide is often given with an infusion of a type of sugar called dextrose and can be injected into a vein or under the skin.
In the past, diazoxide, an oral medication commonly used for high blood pressure, was often used to counteract the effect of sulfonylureas on the insulin-releasing cells of the pancreas. But since the introduction of octreotide, diazoxide has fallen out of favor.
Long term treatment usually involves working with a psychiatrist. Psychotherapy, which is talking to a mental health professional to understand and manage the problem, is often the preferred treatment. Research doesn’t support the use of antidepressants or medication for psychosis for people with factitious hypoglycemia. However, many of these patients may not agree to see a psychiatrist, even if they recognize their diagnosis.
What else can Factitious Hypoglycemia be?
When trying to diagnose low blood sugar levels, or hypoglycemia, doctors might look at a number of different possibilities. They could include:
- Drinking alcohol
- A lack of certain hormones, like cortisol
- Non-insulin-producing tumors
- Insulinoma, a type of tumor that produces too much insulin
- Conditions that result in the body attacking its own insulin, known as insulin autoimmune hypoglycemia
- Low blood sugar caused by accident or on purpose
They would also consider other potential causes that can suddenly trigger hypoglycemia, particularly in people who already have diabetes. These can include infections, severe bodywide infections known as sepsis, and temporary interruptions in the brain’s blood supply, or transient ischemic attacks. These conditions need to be ruled out before starting a more thorough investigation into the causes of the hypoglycemia.
What to expect with Factitious Hypoglycemia
The outlook for people with factitious disorder tends to be quite challenging, and it’s often difficult for them to become completely well, particularly if the condition is recognized late. Factitious disorder is a condition where someone deceives others by appearing sick, by purposely getting sick, or by self-inflicting damage to produce symptoms.
In a long-term study that tracked ten patients with a form of factitious disorder called factitious hypoglycemia – where people fake low blood sugar symptoms – it showed a concerning situation where two out of the ten patients took their own lives. This emphasizes the severity of the condition and the importance of early identification and intervention.
Possible Complications When Diagnosed with Factitious Hypoglycemia
Factitious disorder is a mental health condition that can lead to unfavorable results. Often, patients with this disorder intentionally cause harm to themselves until they have a lasting medical injury. Individuals with factitious hypoglycemia, or artificial low blood sugar, can experience significant health issues if they don’t get medical care quickly to rectify their blood sugar levels. Some of these complications could range from heart rhythm abnormalities and seizures to strokes, comas, and in worse case scenarios, death.
Potential Complications:
- Long-term medical injury
- Heart rhythm abnormalities
- Seizures
- Strokes
- Comas
- Potential death
Preventing Factitious Hypoglycemia
People often don’t fully understand the serious effects of having low blood sugar. Sometimes, individuals may even purposely use insulin injections or similar medication to lower their blood sugar, causing signs of low blood sugar in order to get attention or sympathy. So, if you suspect that a close friend or family member might be doing this – especially if they have access to insulin or other diabetic medicines – it’s very important that you educate them about the risks. Encouraging them to discuss their concerns with their main doctor can help to prevent them from experiencing significant health problems associated with low blood sugar levels.
