title: Importance of insulin immunoassays in the diagnosis of factitious hypoglycemia.
abstract: We report two cases emphasizing the importance of insulin assays for evaluation of hypoglycemia in diabetic patients. Case 1 was a 96/12-year-old female patient with type 1 diabetes mellitus and case 2 was a 1010/12-year-old male patient with DIDMOAD. Both patients were on a basal-bolus insulin regimen. Both were admitted because of persistent hypoglycemia. Analyses of serum samples obtained at the time of hypoglycemia initially showed low insulin and C-peptide levels. Recurrent episodes of unexplained hypoglycemia necessitated measurement of insulin levels by using different insulin assays, which revealed hyperinsulinemic hypoglycemia with low C-peptide levels, findings which confirmed a diagnosis of factitious hypoglycemia. Surreptitious administration of insulin should not be excluded in diabetic patients with hypoglycemia without taking into account the rate of cross-reactivity of insulin analogues with the insulin assay used.
authors.affiliation: Behçet Uz Children's Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey. E-ma-il: korcandemir@gmail.com.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Nalbantoğlu Elmas
authors.forename: Korcan
authors.initials: K
authors.lastname: Demir
authors.forename: Nusret
authors.initials: N
authors.lastname: Soylu
authors.forename: Nilüfer
authors.initials: N
authors.lastname: Çelik
authors.forename: Behzat
authors.initials: B
authors.lastname: Özkan
mesh_terms: D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005162:Factitious Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis*; D007118:Immunoassay / Q000592:standards; D007328:Insulin / Q000008:administration & dosage* / Q000097:blood*; D008297:Male; D014929:Wolfram Syndrome / Q000188:drug therapy*
chemical_list: D007328:Insulin