RT Book, Section
A1 Masharani, Umesh
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1184162669
T1 Factitious Hypoglycemia
T2 Current Medical Diagnosis & Treatment 2022
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264269389
LK accessmedicine.mhmedical.com/content.aspx?aid=1184162669
RD 2024/04/23
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  diabetic  member  of  the  family.  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.