Hypoglycemic Coma May Be Self-Induced by Teens With Diabetes

Some instances of recurrent hypoglycemic coma among adolescents may be induced by the patients who self-administer too much insulin, purposely. The incidence of severe hypoglycemia ranges from 0.02 to 0.97 per patient-month among adolescents with type 1 diabetes. While the fear of recurrence usually prompts changes to decrease the risk, there are a few cases of recurrent severe hypoglycemia.

Dr. Pierre Bougneres and colleagues at Hospital Saint-Vincent-de-Paul in Paris investigated 322 cases of recurring hypoglycemic coma since 1990 in 149 adolescents with type 1 diabetes. According to their report in the February issue of Diabetes Care, 19 patients had a very unusual frequency of coma.

Sixteen of these patients (15 girls and 1 boy), at the time of the event or over the next several years, admitted to surreptitious self-administration of insulin, with an average occurrence of coma of 1.10 per patient-month versus 0.39 per patient month among remaining patients.

One group of seven patients admitted to using insulin to deliberately induce coma. There was one case of attempted suicide using doses of 1,000 to 4,000 units, while the other six used 40 to 60 units. Five of the patients had significant familial difficulties, including incest, hidden abortion, and alcoholism.

The second group of five patients used three to seven night injections of insulin per week of 20 to 30 units in attempts to normalize their blood glucose levels. The impetus appeared to be strong parental pressure to normalize glycemia in response to unreasonable fears of future blindness.

The remaining four patients used secret injections as catch-up to mask periods in which they had skipped their usual injections. Three of these cases were marked by familial difficulties and school failure.

Overall, familial difficulties were documented among 50% of those who self-induced coma, versus 6.0% among the other patients.

To deal with these patients, Dr. Bougneres’ team advises physicians that "all children with more than two repeated comas within a 3-month period should immediately be hospitalized to allow in-depth discussions with physicians, nurses, and psychiatrists after the physician has made clear that secret self-administration of insulin is suspected."

They add: "Instead of struggling with the patient to obtain ‘the truth,’ a firm and comprehensive diagnosis is key to prevent or reduce further recurrence."
Diabetes Care Feb. 2006:29:430-431

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