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.