Insulin Misuse Research Articles

Factitious hypoglycemia in a diabetic: Metabolic studies and diagnosis with radioactive isotopes

A case of “spontaneous hypoglycemia” in a diabetic, due to misuse of insulin, is described. Differentiation from insulinoma was difficult. Some of the anomalous results obtained during standard provocative tests are regarded in retrospect, as due to self-administration of exogenous insulin even though the patient was in hospital and apparently under strict supervision at the time of the tests. This may also explain some previously published reports with anomalous results. Distal pancreatectomy was carried out because of persistent unexplained hypoglycemia with temporary relief of symptoms but subsequent relapse. Correct diagnosis was made when an illicit store of insulin was discovered in the false bottom of a jewel box. This was labeled surreptitiously with 131I which was later demonstrated in the urine, blood, and at the site of injection. Though rare in diabetics, factitious hypoglycemia presents difficult problems in diagnosis.

IDIOPATHIC SPONTANEOUSLY OCCURRING HYPOGLYCEMIA IN INFANTS<subtitle>Clinical Significance of Problem and Treatment</subtitle>

IN KEEPING with tradition concerning the choice of subject for a presidential address, I originally prepared a semiphilosophical dissertation for this occasion. Now, I must apologize to you for the sin of "deviation," because I suddenly decided only a few days ago to scrap that laboriously composed oration and substitute a résumé of some observations that my associates and I have made during the past few years in dealing with the clinical problem of spontaneous hypoglycemia in infants. My seemingly impulsive decision to change to the latter title was the direct result of my seeing the seventh young child, among a series of cases recently examined in our clinic, who had suffered irreparable brain damage from severe hypoglycemia. Three of these were children who were victims of the misuse of insulin in the treatment of diabetes mellitus. The remaining four were examples of severe spontaneous hypoglycemia in infants who were