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A 34-year-old operating theatre nurse has had eight admissions in a year with episodes of sweating and confusion. Today her blood glucose is 1.6 mmol/L (3.0 to 7.7). Samples drawn at the same moment show a markedly raised serum insulin, an undetectable C-peptide and a negative sulfonylurea screen. She has no diabetes, takes no medicines and lives alone. She has asked repeatedly for more tests and was visibly disappointed when told that a laparotomy was not needed. Which one of the following best explains the findings?
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