Hypoglycaemia factitia

According to abbreviationfinder, HF stands for Hypoglycaemia factitia. Hypoglycaemia factitia is low blood sugar with the characteristic symptoms that the patient deliberately brings about. Those affected are usually people with Munchausen syndrome. In addition to the symptomatic treatment of hypoglycaemia, causal therapeutic treatment must be carried out in order to protect the patient from himself.

What is hypoglycaemia factitia?

Patients with hypoglycaemia factitia suffer from the characteristic symptoms of hypoglycaemia. The adrenaline release causes them to tremble, sweat and suffer from tachycardia.

In the case of hypoglycaemia, the blood glucose concentration in the blood falls below a physiologically specified normal value of 60 mg/dl, i.e. 3.3 mmol/l. In newborns, a value of 45 mg/dl or 2.5 mmol/l is already considered a critical limit. Hypoglycaemia manifests itself in the form of a disturbed regulation of glucose release from the liver and glucose uptake in the consuming organs.

Due to a reactive release of adrenaline, symptoms such as tremors, sweating, tachycardia and cravings occur in hypoglycemia. Neuroglycopenic signs due to glucose deficiency in the central nervous system often manifest as drowsiness, speech disturbances, visual disturbances, paraesthesia, or atypical behavior. Extreme hypoglycemia is associated with coma.

Hypoglycaemia factitia is self-induced hypoglycaemia. In the case of the clinical picture, the self-administration of blood sugar-lowering substances causes the blood sugar to drop significantly. Patients intentionally lower their blood sugar to dangerous levels, even though they do not have diabetes and thus risk hypoglycaemia if they take antidiabetic drugs. The hypoglycaemia is therefore wanted by the patient, although or precisely because it is pathological.

Causes

Hypoglycaemia factitia usually occurs in the context of Munchausen syndrome. Those affected by this mental illness regularly pretend to have symptoms in order to receive the attention associated with them when they stay in the hospital. Often this type of disorder occurs in people who are close to chronically ill people.

Munchausen-by-proxy syndrome is a special form, in which parents demand that their healthy children simulate symptoms. The etiology of the syndrome is so far unknown. It is possible that psychological deprivation plays a causal role in the syndrome. In most cases of hypoglycaemia factitia, those affected achieve the desired hypoglycaemia with antidiabetics.

Since they are not diabetics, taking blood-sugar-lowering drugs leads to hypoglycaemia, which is often dangerous, with the characteristic symptoms. The clinical picture differs from involuntarily induced hypoglycaemia due to the psychological component. Diagnosis is relatively difficult, as it requires proof of deliberate provocation of hypoglycemia.

Symptoms, Ailments & Signs

Patients with hypoglycaemia factitia suffer from the characteristic symptoms of hypoglycaemia. The adrenaline release causes them to tremble, sweat and suffer from tachycardia. In addition to ravenous hunger, paleness sets in. Because of the lack of glucose in their central nervous system, patients feel light-headed and confused.

They suffer from speech disorders and vision problems such as double vision. According to those close to them, they exhibit atypical behavior. In addition, sensory disturbances such as deafness or psychotic episodes and even delirium can occur. Seizures and loss of consciousness occur when blood sugar falls below 40 mg/dl. In addition, hypoglycaemia is associated with unspecific accompanying symptoms such as nausea, more or less severe dizziness and headaches.

The clinical picture of patients with hypoglycaemia factitia does not differ from hypoglycemia. The only differentiation criterion is the intentional induction of the symptoms, that is, the desire to suffer through the described symptoms due to low blood sugar.

Diagnosis & course of disease

The diagnosis of hypoglycaemia factitia poses a great challenge for the doctor. Patients will not admit that they caused hypoglycaemia on purpose. A corresponding suspicion can exist based on the anamnesis.

In people who have been diagnosed with Munchausen syndrome, for example, the doctor tends to think of hypoglycaemia factica. Urine and serum are examined in order to prove that the deliberate intake of antidiabetics is the cause of hypoglycaemia. In the laboratory, it shows degradation products of sulfonylurea. If the patient deliberately administered insulin, no increase in C-peptide can be detected when the insulin is elevated.

Complications

Hypoglycaemia factitia causes not only physical but also psychological problems. In most cases, the patient suffers from acute hypoglycaemia, which in the worst case can cause him to lose consciousness. The loss of consciousness often leads to a fall, which can injure the person concerned.

Paralysis and sensory disturbances also occur. The affected person can no longer concentrate properly and is no longer resilient. There is dizziness and severe nausea. The visual acuity can also decrease and it is not uncommon for double vision or blurred vision to occur. The quality of life of the patient is extremely limited for a short time due to the hypoglycaemia factitia.

Since the person affected usually initiates the symptoms themselves on purpose, there are also psychological complaints, so that those affected suffer from severe mental illness and depression. This often leads to social exclusion, which usually requires psychotherapy. In severe cases, treatment in a closed clinic may be necessary. However, there are no complications during the treatment itself.

When should you go to the doctor?

In the case of hypoglycaemia factitia, a visit to a doctor is necessary in any case. In the worst case, the disease can lead to the death of the person affected or to serious permanent damage. Since it is a mental illness, it is primarily the relatives and friends who have to pay attention to the symptoms of hypoglycaemia factitia and lead the affected person to treatment. Patients usually suffer from cramps and severe muscle pain.

A general listlessness and drowsiness also occurs, and those affected can also lose consciousness in extreme cases. Furthermore, permanent dizziness and disturbances in concentration point to the disease. In some cases, deafness or visual problems can occur, which in the worst case can remain permanent. In the case of hypoglycaemia factitia, a general practitioner or a psychologist should be consulted. Treatment often requires a visit to a special clinic to limit the disease.

Treatment & Therapy

In the case of acute hypoglycaemia, the blood sugar must be balanced immediately. The doctor creates such a balance in patients with hypoglycaemia factitia through the intravenous substitution of five percent or ten percent glucose. As a rule, potassium must also be substituted. This substitution takes place through the shift into the interior of the cell.

As soon as the blood sugar 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 an overriding mental illness, which usually corresponds to Munchausen syndrome.

Balancing the blood sugar takes the patient out of danger to life, but does not heal him from the larger context. The patient can only be cured by causal therapy and ideally will never provoke hypoglycaemia again.

The causal treatment for hypoglycaemia factitia corresponds to psychotherapy. The psychotherapeutic treatment of Munchausen syndrome is relatively complex, since the etiology of the clinical picture has not yet been adequately researched.

Prevention

The main purpose of preventing hypoglycaemia factitia is to stabilize the psychological situation. Ironically, patients with Munchausen syndrome do not want to prevent hypoglycaemia factitia, so prevention is often the responsibility of their relatives. Anyone who notices signs of Munchausen syndrome in a person close to them should ideally do everything in their power to hand the affected person over to psychological care as soon as possible.

Aftercare

Once the blood sugar level has been balanced, the follow-up care for hypoglycaemia factitia begins. This includes a therapy that deals with the actual cause. In order to start here, the patient must first have the will to arm themselves against the disease. Psychotherapeutic care is therefore very important so that those affected no longer try to consciously and intentionally bring about hypoglycaemia.

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 pay attention to the typical signs of Munchausen syndrome in order to limit the risk. It is therefore important to get to know the patient’s intentions more closely and to recognize them early in an emergency. A healthy lifestyle helps to counteract the typical tremors and tachycardia.

The problem, however, is that those affected want to bring about these very symptoms themselves. However, the associated visual disturbances make them drowsy and significantly reduce their quality of life. In the course of aftercare and self-help measures, there are therefore no general approaches. Patients at risk require attentive care and must realize for themselves how dangerous hypoglycaemia is for their organism.

You can do that yourself

Hypoglycaemia factitia represents a special form of the disease, since the patients intentionally bring about the typical hypoglycaemia. The temporary symptoms such as tremors, tachycardia, drowsiness and visual disturbances significantly reduce the quality of life of those affected, but the patients want to experience these symptoms. 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 mental disorders, which also make it difficult to help themselves. In principle, the patient must be willing to overcome the disease and not voluntarily bring about any further hypoglycaemia. 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 patient. Because in delirium falls or accidents are possible. Therefore, it is sometimes necessary for patients to receive treatment in a closed mental health institution. Support from relatives and other social contacts usually has a beneficial effect on the progress of therapy. When the underlying mental illness is cured, the hypoglycaemia factitia disappears.

Hypoglycaemia factitia