Endocrine Abstracts

Introduction: Artificial hypoglycemia (AH) is the intentional administration of insulin preparations or the use of oral hypoglycemic agents to lower blood glucose levels. It is one of the variants of Munchausen’s syndrome. Hypoglycemia in non-diabetic patients is a blood glucose level of less than 3.0 mmol/l. AH among all causes of non-diabetic hypoglycemia (NDH) is approximately 4-11%. Identification of such cases is an urgent problem in the differential diagnosis of NDH, especially when insulin analogues are administered, since such insulin in the blood is not detected by many test systems.

Materials and Methods: A 28-year-old female patient complained of hypoglycemia up to 1.8 mmol/l, severe weakness, trembling in the body, which was stopped by taking fast carbohydrates. From the anamnesis it is known that the patient worked as a nurse, had long periods of disability, her family has patients with diabetes mellitus. The patient has been receiving treatment for conversion disorder for a long time. In 2015, diabetes mellitus (DM) has been diagnosed, but due to frequent hypoglycemic conditions, she received insulin episodically. MODY variants and autoimmune DM are excluded. In May 2022, during examination at the Endocrinological Research Center: HbA1c - 5.7%, C-peptide - 1.57 ng/ml, insulin - 12.4 μU/ml, OGTT without deviations. A fasting test was initiated, after 42 hours hypoglycemia was recorded: glucose - 2.53 mmol/l, insulin 0.2 μU/ml, C-peptide 0.22 ng/ml. Hypocorticism and non-islet cell tumour hypoglycemia (NICTH) were excluded. Deliberate administration of insulin analogues is suspected. This blood sample was studied by HPLC-MS/MS, insulin Aspart was detected. When discussing the results, the patient denied the administration of insulin preparations. A conversation was held about the need to take drugs only as directed by a doctor and about the potential danger to life with self-treatment. It is recommended to continue the supervision of a psychiatrist.

Conclusion: The HPLC-MS/MS method greatly simplifies the diagnosis of factitious hypoglycemia and allows you to quickly identify not only oral hypoglycemic drugs, but also insulin analogues. In the case of diagnosing hypoinsulinemic hypoglycemia and excluding its more frequent causes (adrenal insufficiency and NICTH), it is advisable to study a hypoglycemic blood sample by HPLC-MS/MS to determine insulin analogues.