Hypoglycaemia factitia is hypoglycemia with characteristic symptoms that is brought on by the patient with full intention. Most often, affected individuals are those with Munchausen syndrome. In addition to symptomatic treatment of hypoglycemia, causal therapeutic treatment must be given to protect patients from themselves.
What is hypoglycaemia factitia?
In hypoglycemia, the blood glucose concentration in the blood falls below a physiologically intended normal value of 60 mg/dl, or 3.3 mmol/l. In newborns, a value of 45 mg/dl or 2.5 mmol/l is already considered a critical limit. Hypoglycemia manifests itself in the form of disturbed regulation of glucose release by the liver and glucose uptake by the consuming organs. Due to reactive adrenaline release, symptoms of hypoglycemia include tremors, sweating, palpitations, and ravenous hunger. Neuroglycopenic signs due to glucose deficiency in the central nervous system often manifest as drowsiness, speech disorders, visual disturbances, paresthesias, or atypical behavior. Extreme hypoglycemia is accompanied by coma. Hypoglycaemia factitia is self-induced hypoglycemia. In the clinical picture, self-administration of blood glucose-lowering substances causes blood glucose to plummet. Patients intentionally lower their blood glucose to dangerous levels even though they do not have diabetes and thus risk hypoglycemia by taking antidiabetic medications. Thus, hypoglycemia is deliberate on the part of patients, although or precisely because it is pathological.
Causes
Hypoglycaemia factitia usually occurs in the context of Munchausen syndrome. Sufferers of this mental condition regularly feign discomfort in order to receive the associated attention during hospitalizations. Frequently, this type of disorder occurs in persons who are close to chronically ill people. Munchausen by proxy syndrome, in which parents require their healthy children to feign symptoms, is considered a special form. The etiology of the syndrome is unknown so far. Psychological deprivation may play a causative role in the syndrome. In most cases of hypoglycaemia factitia, the affected individuals achieve the desired hypoglycemia by antidiabetic drugs. Since they are not diabetics, taking the blood glucose-lowering drugs causes them to experience often dangerous hypoglycemia with the characteristic symptoms. The clinical picture differs from involuntarily induced hypoglycemia by the psychological component. Diagnosis is relatively difficult because it requires evidence of voluntary provocation of hypoglycemia.
Symptoms, complaints, and signs
Patients with hypoglycaemia factitia suffer from the characteristic symptoms of hypoglycemia. Due to the release of adrenaline, they tremble violently, sweat, and suffer from palpitations. In addition to ravenous hunger, pallor sets in. Because of the lack of glucose in their central nervous system, patients feel dizzy and confused. They suffer from speech disorders and visual disturbances such as double vision. According to those close to them, they exhibit atypical behavior. In addition, sensory disturbances such as numbness or psychotic episodes and even delirium may occur. When blood glucose drops below 40 mg/dl, seizures and unconsciousness occur. In addition, hypoglycemia is associated with nonspecific accompanying symptoms such as nausea, more or less severe dizziness, and headache. The clinical picture of patients with hypoglycaemia factitia does not differ from hypoglycemia. The only differentiating criterion is the voluntary induction of symptoms, that is, the desire to suffer the described symptoms because of hypoglycemia.
Diagnosis and course of the disease
The diagnosis of hypoglycaemia factitia presents a significant challenge to the physician. Patients will not admit to intentionally inducing hypoglycemia. Such a suspicion may be raised by the medical history. For example, in people diagnosed with Munchausen syndrome, the physician is more likely to think of hypoglycaemia factica. Urine and serum are examined in order to detect the deliberate use of antidiabetic drugs as the cause of hypoglycemia. Laboratory tests show the presence of sulfonylurea degradation products.If the patient has voluntarily consumed insulin, no C-peptide elevation can be detected when insulin is elevated.
Complications
Hypoglycaemia factitia causes not only physical but also psychological symptoms. In most cases, the patient experiences acute hypoglycemia, during which, in the worst case, the patient may lose consciousness. Due to the loss of consciousness, it is not uncommon for the patient to fall and injure himself. Furthermore, paralysis and sensory disturbances also occur. The affected person can no longer concentrate properly and is also no longer able to work under pressure. There are feelings of dizziness and severe nausea. Visual acuity may also decrease, and it is not uncommon for double vision or veil vision to occur. Hypoglycaemia factitia causes the patient’s quality of life to be extremely limited for a short period of time. Since the affected person usually initiates the symptoms on purpose, it also leads to psychological discomfort, so that the affected person suffers from severe mental illness and depression. Not infrequently, this leads to social exclusion, for which psychotherapy is usually necessary. In severe cases, treatment in a closed clinic may be necessary. However, no complications occur during the treatment itself.
When should one go to the doctor?
In hypoglycaemia factitia, a visit to a doctor is necessary in any case. In the worst case, the condition can lead to the death of the affected person or serious permanent damage. Since it is a psychological disease, especially the relatives and friends must pay attention to the symptoms of hypoglycaemia factitia and guide the affected person to treatment. As a rule, patients suffer from cramps and severe muscle pain. Also, a general listlessness and drowsiness occurs, and the affected person may lose consciousness in extreme cases. Furthermore, permanent dizziness and disturbances of concentration indicate the disease. In some cases, deafness or visual problems may occur, which in the worst case may remain permanently. In cases of hypoglycaemia factitia, a general practitioner or a psychologist should be consulted. Often, treatment continues to require a visit to a special clinic to limit the disease.
Treatment and therapy
In acute hypoglycemia, blood glucose must be compensated immediately. The physician achieves such compensation in patients with hypoglycaemia factitia by intravenous substitution of five percent or ten percent glucose. As a rule, potassium must also be substituted. This substitution is done by shifting to the inside of the cell. As soon as the blood glucose has stabilized, a potassium shift of the cells can occur. In principle, however, the treatment described in the context of hypoglycaemia factitia is not a causal therapy. In this case, the hypoglycemia is merely the symptom of a superordinate disease of the psyche, which usually corresponds to Munchausen’s syndrome. Balancing the blood glucose takes the patient out of mortal danger, but does not cure him of the larger context. Only causal therapy can cure the patient and thus, ideally, will never provoke hypoglycemia again. Causal treatment is equivalent to psychotherapy in hypoglycaemia factitia. Psychotherapeutic treatment of Munchausen syndrome is relatively complex because the etiology of the clinical picture has not been adequately studied.
Prevention
Prevention of hypoglycaemia factitia is primarily aimed at stabilizing the psychological situation. Ironically, patients with Munchausen syndrome do not want to prevent hypoglycaemia factitia, so prevention often falls to their loved ones. Ideally, anyone who notices traits of Munchausen syndrome in a loved one will do everything possible to place the affected person in psychological care as soon as possible.
Aftercare
Once a balance of blood glucose levels has been achieved, the aftercare of hypoglycaemia factitia now begins. This involves therapy that addresses the underlying cause. In order to start here, the patient must first have the will to arm himself against the disease.Psychotherapeutic care is therefore very important so that those affected no longer try to deliberately and intentionally cause hypoglycemia. The psychological causes are usually very complex, which is why this follow-up therapy can take a long time. At the same time, relatives should watch out for the typical signs of Munchausen syndrome to limit the risk. It is therefore important to get to know the patient’s intentions better and to recognize them at an early stage in the event of an emergency. To combat the typical tremors and palpitations, a healthy lifestyle helps. The problem, however, is that those affected themselves want to bring about precisely these symptoms. But the accompanying visual disturbances make them dizzy and reduce the quality of life considerably. Therefore, in the course of aftercare and self-help measures, there are no blanket approaches. Patients at risk need attentive care and must come to realize on their own how dangerous hypoglycemia is for their organism.
Here’s what you can do yourself
Hypoglycaemia factitia represents a special form of the disease, as patients intentionally induce the typical hypoglycemia. The temporary discomfort, such as tremors, palpitations, lightheadedness, and visual disturbances, significantly limits the quality of life of affected individuals; however, the experience of these symptoms is intentional on the part of patients. For this reason, there are hardly any starting points for self-help measures for people with hypoglycaemia factitia, at least not during a phase of acute hypoglycaemia. At the same time, the patients suffer from psychological disorders that also make self-help more difficult. Basically, patients must have the will to overcome the disease and not to willingly induce further states of hypoglycemia. The existing mental illnesses often make it difficult for patients to seek psychotherapeutic treatment. In some cases, hypoglycaemia factitia leads to complications that are sometimes life-threatening for the sufferers. This is because falls or accidents are possible during delirium. Therefore, it is sometimes necessary for patients to receive treatment in a closed mental health facility. The support of the relatives and other social contacts usually has a beneficial effect on the progress of the therapy. When the underlying mental illness is cured, hypoglycaemia factitia disappears.
