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Surreptitious insulin administration: is it an iatrogenic syndrome?

Sir .—Dr Brouhard 1 recently commented on our report of adolescents who secretively took extra insulin for reasons other than to achieve good glycemic control, ie, surreptitious insulin administration (SIA). 2 Brouhard suggested that not all of our adolescents who practiced SIA had preexistent psychopathology and that SIA was a result [emphasis ours] of taking control from the patient; "these patients resorted to a dangerous method of regaining or initiating some control over their own disease as one aspect of an attempt to achieve independence." This would imply that SIA is an iatrogenic syndrome that results from parents and physicians not allowing the adolescent to become "autonomous." We believe that this interpretation is incorrect and rather that SIA is yet one more way in which psychopathology is manifested when an emotionally disturbed adolescent is unfortunate enough to also have insulin-dependent diabetes mellitus (IDDM). In our report, all patients had psychopathology,