[Hypoglycemia provoked by clandestine injections of insulin in the diabetic child]. / Hypoglycémies provoquées par injections clandestines d'insuline chez l'enfant diabétique.

The treatment of insulin-dependent diabetes mellitus in a child generates new constraints in the family and requires adjustments of the daily routine. Refusal of these changes may lead to poor compliance with the treatment regimen. Poor or mistaken daily results and repeated episodes of ketoacidosis may occur as a result. Clandestine injection of insulin responsible for apparently inexplicable episodes of hypoglycemia is less common. Three new cases are reported herein. Clinical diagnosis is fairly easy and biological findings can provide confirmation. Acknowledgement of the injections by the patient is important in order to gain insight into his or her motives. Depression is known to be common among diabetics and the injections may be a symptom of depression. Another possibility is that the child expects to achieve an "irrational recovery" from the disease by taking control over the treatment. Furthermore, a child with access to a highly active drug like insulin can use this situation to acquire and maintain exceptional status within the family. The diagnosis of factitious hypoglycemia requires in every case an in-depth evaluation which may lead to psychotherapy for the child or for the entire family.