A case of factitious remission of type I diabetes in an adolescent girl is reported. The clue to diagnosis came from an inconsistency between clinic blood glucose levels and the corresponding values of glycosylated haemoglobin.
Investigations of 24 h hormone and metabolite profiles demonstrated discrepancies between insulin dose, endogenous insulin production and free insulin levels which provided confirmatory evidence of surreptitious self-administration of insulin by the patient.
References
1.
MadsbadS. Prevalence of residual B-cell function and its metabolic consequences in Type I insulin dependent diabetes. Diabetologia1983; 24: 141–7.
2.
BinderCFaberOK. Residual beta cell function and its metabolic consequences. Diabetes1978; 27: (Suppl 1): 226–9.
3.
FaberOK. B-cell function and blood glucose control in insulin dependent diabetics within the first month of insulin treatment. Diabetologia1977; 13: 263–8.
PondH. Special problems of the diabetic child. Practitioner1968; 200: 527–32.
6.
TattersallRWalfordS.Brittle diabetes in response to life stress: ‘cheating and manipulation’ In: PickupJ (ed) Brittle Diabetes.Oxford: Blackwell Scientific, 1985; 87–9.
7.
JovanovichLPetersonCM. The clinical utility of glycohemoglobins. Am J Med1981; 70: 331–8.
8.
JacksonRLHessRLEnglandJD. Hemoglobin A1c values in children with overt diabetes maintained in varying degrees of control. Diabetes Care1979; 2: 391–5.
9.
LloydBBurrinJSmythePAlbertiKGMM. Enzymic fluorometric continuous flow assays for blood glucose, lactate, pyruvate, alanine, glycerol and 3-hydroxybutyrate. Clin Chem1978; 24: 1724–9.
10.
PriceCPLloydBAlbertiKGMM. A kinetic spectrophotometric assay for rapid determination of acetoacetate in blood. Clin Chem1977; 23: 1893–7.
11.
TurnellDCPriceCPFranceMM. A57Co-soap assay for plasma total non-esterified fatty acids compared with a gas liquid chromatographic method. Clin Chem1980; 26: 1879–82.
12.
HalesCNRandlePJ. Immunoassay of insulin with insulin antibody precipitate. Biochem J1963; 88: 137–46.
13.
Massi-BenedettiMNoyGANosadiniRMetabolic abnormalities in ‘brittle’ diabetes. Diabetologia1980; 19: 297.
