Insulin misuse: a review of an overlooked psychiatric problem.

A number of forms of insulin misuse, other than the usual noncompliance, have been reported in the literature on the treatment of diabetes mellitus. These include attempted and completed suicide, factitious hypoglycemia, Munchausen syndrome by proxy, and the use of insulin by substance abusers. Such misuse has involved diabetic patients, their family members and medical staff, as well as others. The reports of suicide attempts reveal an equal distribution of misuse between the sexes (rather than the expected preponderance of females), underrepresentation of adolescents, and a high rate of recurrence. Recommendations for treatment are discussed for clinicians and investigators regarding this overlooked problem.