Hypoglycemia due to surreptitious injection of insulin. Identification of insulin species by high-performance liquid chromatography.
OBJECTIVE
To identify the circulating species of insulin after separation by high-performance liquid chromatography (HPLC) in patients with factitious hypoglycemia.


METHODS
In three of four patients presented, the diagnosis of surreptitious insulin injection was made by documenting the presence of animal insulin in the circulation after separation of the circulating insulin forms by HPLC.


RESULTS
Animal insulin was identified.


CONCLUSIONS
Thus, the identification of the circulating form of insulin in the circulation by HPLC may be a useful adjunct in the diagnosis of factitious hypoglycemia if animal insulin has been injected and if the simultaneously measured concentrations of insulin and C-peptide are inconclusive.
Given
B D
BD
Department of Medicine, University of Chicago, Pritzker School of Medicine, Illinois.
Ostrega
D M
DM
Polonsky
K S
KS
Baldwin
D
D
Kelley
R I
RI
Rubenstein
A H
AH
D000328:Adult; D002096:C-Peptide / Q000097:blood; D002851:Chromatography, High Pressure Liquid; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000523:psychology; D007223:Infant; D007273:Injections, Intramuscular; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood
D002096:C-Peptide; D007328:Insulin