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

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. Since 1990, we investigated 322 cases of recurring hypoglycemic comas in 149 adolescents with type 1 diabetes. All went through careful interviews and medical examinations. Plasma …