Surreptitious Insulin Administration

Consider the following reports:

Patient 1.—An 11-year-old boy with a three-year history of insulin-dependent diabetes mellitus was referred to the Children's Diabetes Management Center, Galveston, Tex, for a decreasing insulin dose and marked hypoglycemia with a recent onset of seizures. His metabolic control had always been good, with no episodes of Ketoacidosis; his mother rigidly controlled his insulin administration and food intake. The patient had a two-year history of mild hypoglycemia for which he received carbonated sugar-containing drinks and cake. Because of the increasing frequency of these hypoglycemic episodes, his insulin dosage was decreased from a total of 30 U/d to 8 U/d over the six-month period before admission. During a five-day evaluation, his blood glucose levels increased, as did his insulin requirements (0.8 U/kg/d). His mother continued to be reluctant to allow her son any freedom to manage his disease. Although the child admitted that he had occasionally given