Factitious hypoglycemia occurs when you intentionally induce low blood sugar. It can lead to unnecessary and expensive medical care as doctors try to determine the cause of the hypoglycemia.

Intentionally lowering your blood sugars to induce hypoglycemia can be a dangerous practice, but it’s more common than you might think.

Known as factitious hypoglycemia, this practice can be a result of misusing insulin and trying to manipulate blood sugars for a particular reason. Some people may also try to force hypoglycemia if they’re required by insurance to experience a certain number of low blood sugars to be eligible for diabetes technology like a continuous glucose monitor (CGM).

No matter the reason, intentionally inducing hypoglycemia is dangerous and medical professionals warn against this practice.

This article will explain more about factitious hypoglycemia, how you may recognize it, and how dangerous this can be.

Factitious hypoglycemia happens when a person intentionally lowers their blood sugar levels. This is one of the most challenging forms of hypoglycemia to diagnose.

This happens when someone uses insulin and sulfonylureas drugs but not Metformin or other insulin-sensitizing drugs.

It’s uncommon in people who don’t live with diabetes.

However, those without diabetes can get medications that lower their blood sugar levels and misuse them. Doctors may suspect factitious hypoglycemia in people with psychiatric issues like major depressive disorder or people who have a history of past suicide attempts.

You may recognize these typical symptoms of low blood sugar, including:

  • dizziness
  • fatigue
  • hunger
  • sweating
  • shaking or trembling
  • difficulty concentrating
  • blurry vision

In severe cases, hypoglycemia can result in seizures or coma.

People who have patterns of recurring hypoglycemia may experience less severe, hard-to-identify symptoms.

To be diagnosed with factitious hypoglycemia, a person must first have symptoms of hypoglycemia and a blood sugar level below 70 mg/dL. Their blood sugar levels must also improve after glucose is administered. Then, other causes for hypoglycemia must be ruled out.

When other causes of low blood sugar are not evident, doctors may be able to identify factitious hypoglycemia using information from blood testing done when a person’s blood sugar levels are below 70 mg/dL.

According to a 2018 study, a doctor’s suspicion may still be the best tool for detecting this condition. That’s because many lab results are unable to detect certain subtleties that may indicate factitious hypoglycemia.

Factitious hypoglycemia is considered a psychiatric disorder.

This is because, unlike traditional hypoglycemia, which can happen without someone’s knowledge, this type of hypoglycemia is when someone intentionally chooses to make this happen and forces their blood sugars to drop — possibly to dangerously low levels.

That behavior may be an effort to gain attention from medical professionals as well as their family and friends. They may not realize the potential severity of low blood sugar.

Specific stats on insulin or sulfonylurea misuse are not available. But the National Institute on Drug Abuse reports that roughly 14.3 million people 12 years or older in 2021 admitted to misusing a prescription psychotherapeutic drug in the past 12 months. This same study also revealed that approximately 5% of 12th graders admitted to misusing a prescription drug in 2022.

Because of the psychiatric elements at play, evaluation by a psychiatrist is frequently an important part of the diagnosis and treatment of factitious hypoglycemia.

What if insurance requires a certain amount of hypoglycemia?

Some people with diabetes may also intentionally induce hypoglycemia in order to convince their insurance companies to cover diabetes devices like a CGM.

Traditionally, insurers have been reluctant to cover this technology without first showing “medical necessity,” and that has often included a certain number of low blood sugars.

That insurance requirement has eased in recent years as CGM coverage has become more common, especially for those with type 1 diabetes. But many with type 2 diabetes still face those access hurdles set by payers.

Factitious hypoglycemia can result in serious hypoglycemic symptoms like seizures and coma. It can also result in costly hospital visits and testing as doctors treat a person’s low blood sugar and rule out other potential causes of hypoglycemia.

Factitious hypoglycemia is most dangerous, though, because many people continue to grapple with it and harm themselves until they have a permanent injury.

People with factitious hypoglycemia may not be able to have a productive life, and their mental health challenges may put their lives in danger.

The psychosocial aspects of life with diabetes can be challenging. But discussions with your healthcare team and mental health professionals can help address underlying issues for factitious hypoglycemia, and seeking that help can be beneficial.

It’s important to first return blood sugar levels to normal. This may happen through glucose tablets, injections, or IV (intravenous) treatments. Additional medications may also be needed to counteract the effects of sulfonylurea medications if they were used to induce hypoglycemia.

For long-term treatment and to prevent future episodes of factitious hypoglycemia, psychotherapy is recommended. So far, antidepressant and antipsychotic medications have not been found to be effective in treating this condition.

Factitious hypoglycemia occurs when a person purposefully lowers their blood sugar levels. People may experience a variety of hypoglycemia symptoms as a result of their low blood sugar levels, including seizures or coma in severe cases.

Factitious hypoglycemia often involves the improper use of insulin or insulin secretagogues for psychiatric or insurance reasons. The long-term outlook for factitious hypoglycemia is poor, but therapy can help prevent those affected from continuing to harm themselves.