Recurrent Comas Due to Secret Self-Administration of Insulin in Adolescents With Type 1 Diabetes

Recurrent Comas Due to Secret Self-Administration of Insulin in Adolescents With Type 1 Diabetes
Received for publication October 15, 2005. Accepted for publication October 15, 2005.
Pascal Boileau, MD, PHD, Brigitte Aboumrad and Pierre Bougnères, MD, PHD
Diabetes Care
© 2006 by the American Diabetes Association

Pathophysiology/Complications
Brief Report

Pediatric Endocrinology and Diabetes Center, Hospital Saint-Vincent-de-Paul, Université René Descartes, Paris, France

Address correspondence and reprint requests to Pierre Bougnères, Pediatric Endocrinology & Diabetes Center, Université René Descartes, Hospital Saint-Vincent-de-Paul, 82 Ave Denfert-Rochereau 75674, Paris Cedex 14, France. E-mail: pierre.bougneres@paris5.inserm.fr

INTRODUCTION

The incidence of severe hypoglycemia ranges from 0.02 to 0.07 per patient-month in a large series of adolescents with type 1 diabetes (1–4). Parents and physicians usually attribute these hypoglycemic accidents to mistakes in the management of diabetes: excessive insulin dosage, unusual exercise, meal omission, etc. In one-third of these episodes, however, the circumstances of hypoglycemia remain unclear (5,6). The fear of recurrence usually prompts the patient or his parents to decrease insulin doses and increase glucose monitoring (7). In few cases, however, severe hypoglycemia repeats, leading physicians to search for an organic cause. These investigations are almost always negative. Because lack of compliance is frequent among adolescents, we hypothesized that recurrent comas could be due to self-administration of insulin of which parents and physicians are not aware, a cause that has received little attention in literature (8–10) but carries a high risk of medical and judicial errors, morbidity, or even mortality.

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