Endocrine Abstracts

A 49 year old lady presented to the hospital unconscious with severe hypoglycaemia. She had type 1 diabetes for 24 years and coeliac disease. She was hypo-unaware and had multiple admissions with DKA and hypoglycaemia over the years. She did not engage in the self-management of diabetes, therefore, insulin was being injected by the carers in the community and by nurses in the hospital. Her erratic and unpredictable glycaemic control was attributed to non-compliance. She admitted to eating gluten diet, and recent upper GI endoscopy showed mark villous atrophy. Her meal size and pattern were variable at home. During admission, she was found to be self-injecting her own insulin without a clinical indication. She was assessed by a psychiatrist and was diagnosed to have a personality disorder. She was deemed to have full mental capacity and insight into her condition and the harm that can occur with her behaviour. She was seen by a psychologist and admitted to self-injecting insulin without a clinical indication. It transpired that this was due to an ongoing court battle with her children, and the secondary gain was to get the attention of her children. Diabetes can contribute to the pathogenesis of psychiatric disorders, and some psychiatric disorders are significant risk factors for the development of diabetes. Up to 45% of mental disorders and severe psychological distress goes undetected in people being treated for diabetes. Psychiatric disorders co-existing with diabetes include delirium, mood disorders, substance abuse, anxiety, eating disorders and psychosis. There could also be some overlap between physical features of diabetes especially hypoglycaemia and symptoms of psychiatric disorders. Physicians and endocrinologists should actively seek these issues especially in people with ‘brittle’ diabetes as early recognition and treatment of psychiatric and behavioural problems may lead to satisfactory diabetes control and avoid hospital admissions.