Severe hypoglycemias in a diabetic man by surreptitious self-injections of an insulin analogue

Annales de biologie clinique
Caroline RouvellatSafouane Hamdi

Abstract

A 44 years-old diabetic male patient was admitted several times to the emergency department of Albi Hospital (France) for nocturnal hypoglycemias with losses of consciousness. The initial blood analysis, performed on a Cobas(®) analyzer, retrieved low levels of insulinemia. This patient was treated by analogues of insulin and did not present any comorbidities. Moreover, an extensive check-up did not retrieve any evident cause for these hypoglycemias. After a severe hypoglycemic coma that occurred during the last hospitalization when insulinotherapy was interrupted, the staff suggested the possibility of a factice hypoglycemia by surreptitious administration of insulin. Hormonal assays were then performed on a Centaur(®) analyzer, which is able to recognize insulin aspart and glargine. They revealed elevated concentrations of insulin along with low levels of C-peptide. Such a blood profile is consistent with an exogenous administration of insulin or its analogues. On the basis of this biological clue, the patient was questioned again and he finally admitted self-injection of insulin aspart. This case gives us the opportunity to review the diabetic hypoglycemia, to point out the particularities of the blood assays of insulin anal...Continue Reading

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