Non-suicidal self-injury (NSSI) is a maladaptive behaviour of young adolescents to cope with stress. It is well described in literature and well classified in DSM5 with a prevalence of 8-12% in teenage population. These are often impulsive behaviours and are not associated with suicidal intent.  The common documented stereotypic forms of NSSI are cutting, scratching, biting, burning, embedding or banging. There has been no report of self-overdosing of insulin as a form of NSSI.  

We describe a case of 24-year old university student with type I diabetes diagnosed at age 18. Her past history included craniosynostosis requiring surgery at 7 months and 12 months of age. She was diagnosed with epilepsy 2 years ago  with MRI showing minor grey matter heterotopia. She started with a self-cutting behaviour but then transitioned to self-injecting insulin as a way to deal with her life stressors. This resulted in multiple dangerous hypoglycaemic episodes requiring frequent presentations to the hospital. Some of these episodes were also complicated by seizures.

This posed difficult management challenges. She was frequently admitted for glycaemic stabilisation in the wards and did not have hypoglycaemic episodes under supervised insulin administration by the nursing staff. She was managed with frequent clinic visits and support from the diabetes educators. She was also referred for psychology input to help manage her life stressors. She gradually developed good insight into to her problems, disclosed her behaviours and managed to control these impulsive behaviours with ongoing intensive psychological counselling for coping strategies.

Literature review suggests that NSSI is “contagious” via social media and Internet. We believe this condition is under recognised in young people with diabetes, as hypoglycaemia is often attributed to poor compliance or lifestyles issues. Unlike other forms of NSSI that almost always leave injury marks, self overdosing of insulin is much harder to detect other than the unstable blood glucose levels. Even with a non-suicidal intent, over dosing of insulin can have hazardous consequences. Diabetes staff needs to be aware of this presentation of hypoglycaemia in high-risk young people with diabetes so that prompt psychological interventions can be initiated.