c-peptide and Insulin-Coma

The medical history of a 43-year-old non-insulin-dependent diabetic patient is presented. The exact diagnosis of the cause of repetitive and severe hypoglycaemic episodes proved to be difficult. Finally, high serum insulin and low C-peptide values were found in peripheral venous blood during hypoglycaemia resulting in an elevated (> 1.0) molar ratio of insulin to C-peptide. The laboratory findings were assessed as consequences of surreptitious insulin administration. Factitious hypoglycaemia could be considered as a clinical manifestation of Munchhausen syndrome. Confronting the patient with evidences of surreptitious insulin injections, hypoglycaemic episodes abruptly discontinued to occur.

Topics: Adult; C-Peptide; Diabetes Mellitus, Type 2; Female; Humans; Hypoglycemia; Insulin; Insulin Coma; Munchausen Syndrome; Self Medication

To examine the incidence of hypoglycemic coma in children with insulin-dependent diabetes mellitus (IDDM) over 8 yr from 1981 to 1988 and to investigate the importance of residual beta-cell function of HbA1 levels and other variables as risk factors for hypoglycemic coma.. The study consisted of 155 children with IDDM aged less than 16 yr at study entry. Mean age at onset of diabetes was 7.9 yr (range 1.1-15.6 yr). We made a prospective assessment of hypoglycemic coma episodes, with a standardized questionnaire, over a total observation time of 816.6 person-yr. Three monthly clinical and laboratory examinations, which included determinations of C-peptide and HbA1 levels, were conducted. We compared children with hypoglycemic coma (cases) with children without hypoglycemic coma (controls) in a case-control analysis matched for diabetes duration. Yearly incidence of hypoglycemic coma, calculated as the number of subjects having an attack in 1 yr divided by the cumulative number of person-years for that year, was measured. Univariate and multivariate odds ratios were calculated from logistic regression.. Over the first 4 yr, the average yearly incidence was 4.4/100 person-yr compared with 7.4/100 person-yr during the later 4 yr (P less than 0.0001). This tendency was accompanied by intensification of insulin treatment with an increase in the mean number of daily injections and a decrease in mean HbA1 levels. In the case-control analysis, absent residual beta-cell function was the most important risk factor for hypoglycemic coma (adjusted odds ratio 7.8, 95% confidence intervals 2.0-31.2), followed by near-normal HbA1 levels (adjusted odds ratio 4.5, 95% confidence intervals 1.9-10.5).. In this group of children, improvement of glycemic control apparently led to an increase in the incidence of severe hypoglycemia. In children with recurrent hypoglycemic coma and undetectable C-peptide levels, it may be safer to aim for somewhat less tight glycemic control.

Topics: Adolescent; Animals; Biomarkers; C-Peptide; Child; Diabetes Mellitus, Type 1; Female; Glycated Hemoglobin; Humans; Incidence; Insulin; Insulin Antibodies; Insulin Coma; Male; Odds Ratio; Recombinant Proteins; Regression Analysis; Risk Factors; Swine; Switzerland

Topics: C-Peptide; Child Abuse; Child, Preschool; Humans; Hypoglycemia; Insulin; Insulin Coma; Male