Factitial Hypoglycemia

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Abstract
With the development of a technique1 to measure insulin antibodies in plasma, the diagnosis of factitial hypoglycemia due to the surreptitious administration of insulin can be made with certainty, thereby sparing the patient unnecessary pancreatic exploration and resection in search of an insuloma. Patients 1 and 2 were mentioned but not described in a previous report.2 The case of patient 3 of this communication represents the first report, to our knowledge, of the surreptitious use of both insulin and a sulfonylurea. Methods Whole blood glucose was determined by an auto-analyzer ferricyanide technique.3 Plasma insulin was determined by the double antibody radioimmunoassay of Morgan and Lazarow.4 Insulin antibodies were assayed by the method of Skom and Talmage.1 Patient Summaries Patient 1. —A 48-year-old registered nurse began to experience spells of generalized weakness, periorbital numbness and tingling, diaphoresis, tremulousness, and double vision in 1960. These episodes usually