62 一位30歲的醫院工作人員，因意識不清，行為異常送醫，經檢查血糖值為42 mg/dL，無糖尿病史，惟其弟為第一型糖尿病患，但病人數度於早班後不久發生類似狀況。抽血檢驗發現病人血中胰島素濃度偏高，而C-肽（c-peptide）濃度偏低，其診斷最可能為：
反應性低血糖（reactive hypoglycemia） 早期糖尿病
人為低血糖（factitious hypoglycemia） 胰島素瘤（insulinoma）

ANS C


the sole interest in C-peptide was as a marker of insulin secretion

The pancreas of patients with type 1 diabetes is unable to produce insulin and therefore they will usually have a decreased level of C-peptide, whereas C-peptide levels in type 2 patients are normal or higher than normal. Measuring C-peptide in patients injecting synthetic insulin can help to determine how much of their own natural insulin these patients are still producing, of if they produce any at all.


SO IN THIS PATIENT, IT IS FACTITIOUS HYPOGLYCEMIA. GIVEN THAT THE C PEPTIDE IS LOW. BUT INSULIN HIGH, THE PATIENT MAY HAVE GIVEN HIMSELF INSULIN AT UNADJUSTED DOSE.

HE HAS HIGH PROBABILIYT OF TYPE1 DM