Clinical Review Lesson of the week

Insulin as a substance of misuse in a patient with insulin dependent diabetes mellitus

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7222.1417 (Published 27 November 1999) Cite this as: BMJ 1999;319:1417
  1. Eugene M Cassidy, registrar in psychiatrya,
  2. D J O'Halloran, consultant physicianb,
  3. Siobhán Barry, consultant psychiatrista
  1. a Department of Psychiatry, Cluain Mhuire Service, Blackrock, County Dublin, Republic of Ireland
  2. b Cork University Hospital, Cork, Republic of Ireland
  1. Correspondence to: Dr Barry
  • Accepted 14 August 1998

Doctors should be alert to the possibility of insulin misuse, and should consider psychological evaluation, in an insulin dependent diabetic patient with poor control

The relation between substance misuse and poor compliance with treatment is well established in both general medicine and psychiatry. 1 2 Although young patients with insulin dependent diabetes mellitus may have lower rates of comorbid substance misuse,3 there is direct evidence that their compliance with treatment is poor.4 Patients with insulin dependent diabetes mellitus have an increased risk of developing a psychiatric disorder, particularly in the early course of their illness,3 and treating the psychiatric disorder improves glycaemic control.5

Hypoglycaemic events are common in people with insulin dependent diabetes mellitus6 and may be associated with cognitive, affective, and sometimes life threatening sequelae.7 Specific mood changes caused by changes in blood glucose concentrations are idiosyncratic, and although negative affective states are the most common, positive changes such as giddiness and euphoria are also seen.8 Although there is a strong relation between severe hypoglycaemia and tight glycaemic control,9 cases of deliberate misuse of insulin have been reported. Typically, these patients either attempt suicide or feign illness.10 We report the rare case of a patient with insulin dependent diabetes …

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