TY  - CHAP
M1  - Book, Section
TI  - Factitious Hypoglycemia
A1  - Masharani, Umesh
A2  - Papadakis, Maxine A.
A2  - McPhee, Stephen J.
A2  - Rabow, Michael W.
A2  - McQuaid, Kenneth R.
PY  - 2023
T2  - Current Medical Diagnosis & Treatment 2023
AB  - Factitious  hypoglycemia  may  be  difficult  to  document.  A  suspicion  of  self-induced  hypoglycemia  is  supported  when  the  patient  is  associated  with  the  health  professions  or  has  access  to  diabetic  medications  taken  by  a  member  of  the  family  who  has  diabetes.  The  triad  of  hypoglycemia,  high  immunoreactive  insulin,  and  suppressed  plasma  C-peptide  immunoreactivity  is  pathognomonic  of  exogenous  insulin  administration.  Insulin  and  C-peptide  are  secreted  in  a  1:1  molar  ratio.  A  large  fraction  of  the  endogenous  insulin  is  cleared  by  the  liver,  whereas  C-peptide,  which  is  cleared  by  the  kidney,  has  a  lower  metabolic  clearance  rate.  For  this  reason,  the  molar  ratio  of  insulin  and  C-peptide  in  a  hypoglycemic  patient  should  be  less  than  1.0  in  cases  of  insulinoma  and  is  greater  than  1.0  in  cases  of  exogenous  insulin  administration  (see  Hypoglycemia  Due  to  Pancreatic  B  Cell  Tumors,  above).  When  sulfonylureas,  repaglinide,  and  nateglinide  are  suspected  as  a  cause  of  factitious  hypoglycemia,  a  plasma  level  of  these  medications  to  detect  their  presence  may  be  required  to  distinguish  laboratory  findings  from  those  of  insulinoma.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1193133368
ER  -