Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: a case report

Abstract

Factitious disorder is a psychologic problem which may cause symptoms of a disease which is non-compliance with patient physical exam. Some cases of brittle diabetes are because of underlying psychologic disorder such as factitious disorder or Munchausen syndrome. In this paper a 17-years old female is presented with factitious hyperglycemia and DKA-like symptoms such as nausea, vomiting and severe abdominal pain. Finally with subtle monitoring it was found that the cause of patient's hyperglycemia despite high dose insulin prescription was impregnating her finger into the date palm in the context of the factitious disorder. The patient had different deceptive behaviors depending on the method of treatment. She used every trick to mislead the medical team. In Munchausen syndrome, patient is unaware of his problem that mimic an episode of diabetic ketoacidosis. Thus psychotherapy is the main treatment of this factitious hyperglycemia. The main aim of this report is consideration of factitious hyperglycemia in patients with brittle diabetes mellitus.

Insulin as a Tool in Factitious Dysglycemia

“…The management plan should be objective to diagnose the fabricated illness, not its motive, or why the patient had such deceiving behavior [ 10 , 19 ]. It is imperative to remember that individuals with genuine medical problems may also falsify symptoms and that individuals with FD are suffering and need expert care [ 8 , 16 ].…”

“…Genuine illnesses such as brittle DM may have a psychiatric background that contributes to its pathogenesis, considering FD as an etiology. This may explain the partial recovery of brittle DM in about 50% of cases after treating the underlying causes, while others may need long-term psychotherapy [ 19 ].…”

Determinants of adherence to insulin and blood glucose monitoring among adolescents and young adults with type 1 diabetes in Qatar: a qualitative study

“…Patients' motives varied, such as mental disorders like major depression or factitious disorder (FD) and/or suicidal ideation. 31,34,[90][91][92] Induced hypoglycemia was also used to justify eating sweets and carbohydrate-rich meals. 31 Factitious dysglycemia should be considered a possible cause of brittle diabetes and requires specialist consultation.…”

“…31 Factitious dysglycemia should be considered a possible cause of brittle diabetes and requires specialist consultation. 90,92 However, the literature on FDs from the Arab region is limited, 93,94 with only one report on Iraqi women with type 1 and type 2 diabetes. 92 More information is needed from the Arab region to clarify FD's clinical profile and implications for T1D.…”

A Case of Munchausen Syndrome Presenting as a Cushing Syndrome in a Patient with Major Depressive Disorder

“…1 Uskudar University, Psychiatry Department, Assistant Professor of Psychiatry, Istanbul, Turkey, habiberensoy@yahoo. com 2 Medical Faculty of Istanbul University, Prof. of Psychiatry, Head of Consultation Liasion, Istanbul, Turkey, mineoz-kan_klp@yahoo.com 3 Endocrine Research Center, Professor in Endocrinology, Tabriz University of Medical Science, Tabriz, Iran, dr_niafar@ yahoo.com 4 Endocrine Research Center, Internal Medicine Resident, Tabriz University of Medical Science, Tabriz, Iran, tahsinis@ tbzmed.ac.ir Introduction M unchausen's syndrome is a psychiatric problem in which patients inflict an illness on themselves with the aim of playing a role of being sick [1,2]. Munchausen's syndrome classified as a factitious disorder in the latest version of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [3].…”