title: Prime-time hypoglycemia: factitious hypoglycemia during insulin-pump therapy.
abstract: Unexplained hypoglycemia in a pediatric diabetic patient can perplex even the savviest health care providers and lead to an extensive medical workup. We present here the cases of 2 children with type 1 diabetes mellitus treated with insulin pumps who were hospitalized for episodes of hypoglycemia. Review of their insulin pumps revealed normal basal and bolus insulin delivery. However, subsequent review of the priming history in the pump revealed that both children were receiving additional insulin under the manual-prime function, which is not included in the daily totals and, therefore, was initially unnoticed. Ultimately, both children confessed to surreptitiously using this priming function to self-administer extra insulin. It is important that health care professionals who are caring for diabetic patients be aware of this possibility.
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, State University of New York, Stony Brook, NY 11794-8111, USA.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Osipoff
authors.forename: Nadia
authors.initials: N
authors.lastname: Sattar
authors.forename: Mireya
authors.initials: M
authors.lastname: Garcia
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003937:Diagnosis, Differential; D003927:Diet, Diabetic / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005162:Factitious Disorders / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis* / Q000523:psychology; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects* / Q000031:analogs & derivatives; D061267:Insulin Aspart; D000069036:Insulin Glargine; D007332:Insulin Infusion Systems / Q000009:adverse effects* / Q000523:psychology; D049528:Insulin, Long-Acting; D008297:Male; D012651:Self Medication; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; D061267:Insulin Aspart