Background: Glycemic control in pregnancy complicated by diabetes is important. Spontaneous symptomatic hypoglycemia, in the absence of glucose-lowering treatment, is rare and requires evaluation to prevent harm.
Case: As a result of hypoglycemia, a pregnant woman with type 2 diabetes mellitus had progressive reduction of her insulin requirements until treatment was discontinued at 27 weeks. Despite this, she reported persistent episodes of hypoglycemia. Investigation of possible causes resulted in the discovery that she was covertly treating herself with insulin.
Conclusion: Factitious hypoglycemia should be considered as part of the differential diagnosis of unexplained hypoglycemia. Blood sampling during an episode of hypoglycemia is pivotal in this assessment.