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Vincent Marks



Clinical presentation—discussion of the high incidence of spontaneous hypoglycaemia in elderly sick hospital inpatients, which can lead to false accusations of malicious insulin or sulphonylurea administration.

Factitious hypoglycaemia—discussion of detection of new synthetic insulin analogues.

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date: 27 September 2021

Hypoglycaemia is defined as a blood glucose concentration below 3.0 mmol/litre, which is clinically important because of its effect on brain function. Much the commonest cause is excessive (in relation to intake of food and drink) administration of insulin or sulphonylurea drugs to patients known to have diabetes, but there are many rarer causes including insulinoma, toxins (alcohol), organ failure (hepatic), endocrine diseases (adrenal insufficiency, pituitary insufficiency), non-islet cell tumour hypoglycaemia, autoimmune insulin syndrome, factitious or felonious administration of insulin/sulphonylureas, and infections (malaria)....

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