Duration of hypoglycemia and need for intravenous glucose following intentional overdoses of insulin

Stapczynski, J. Stephan; Haskell, Richard J.

doi:10.1016/s0196-0644(84)80513-2

Cited by 36 publications

(28 citation statements)

References 22 publications

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“…There has been only 1 reported correspondence for monitoring plasma insulin levels on a daily basis in patients with insulin overdoses, albeit with underdosing basal glucose infusion rates in 2 of 3 patients. 19 We have shown in our case report that monitoring daily plasma insulin levels and adjusting treatment on a day-to-day basis in terms of basal glucose infusions, provides for less opportunities of episodic hypoglycemia. Following daily plasma insulin levels also allows a de-escalation in therapy from 10% dextrose on day 1 to 5% dextrose, and finally to no IV fluid replacement on day 5.…”

Section: Discussionmentioning

confidence: 76%

Massive Insulin Overdose Managed by Monitoring Daily Insulin Levels

Mork

Killeen

Patel

et al. 2011

American Journal of Therapeutics

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We present a case of a significant insulin overdose that was managed by monitoring daily plasma insulin levels. A 39-year-old male with poorly controlled diabetes mellitus presented to the Emergency Department via emergency medical services after an attempted suicide by insulin overdose. In the attempted suicide, he injected 800 U of insulin lispro and 3800 U of insulin glargine subcutaneously over several parts of his abdomen. The patient was conscious upon arrival to the emergency department. His vital parameters were within normal range. The abdominal examination, in particular, was nonfocal and showed no evidence of hematomas. He was awake, alert, conversant, tearful, and without any focal deficits. An infusion of 10% dextrose was begun at 100 mL/h with hourly blood glucose (BG) checks. The patient was transferred to the intensive care unit where his BG began to decrease and fluctuate between 50 and 80 mg/dL, and the rate of 10% dextrose was increased to 200 mL/h where it was maintained for the next 48 hours. The initial plasma insulin level was found to be 3712.6 uU/mL (reference range 2.6-31.1 uU/mL). At 10 hours, this had decreased to 1582.1 uU/ml. On five occasions, supplemental dextrose was needed when the BG was <70 mg/dL. Thirty-four hours after admission, the plasma insulin level was 724.8 uU/mL. Fifty-eight hours after admission, the plasma insulin level was 321.2 uU/mL, and the 10% dextrose infusion was changed to 5% dextrose solution at 200 mL/h. The plasma insulin levels continued to fall daily to 112.7 uU/mL at 80 hours and to 30.4 uU/mL at 108 hours. He was transferred to an inpatient psychiatric facility 109 hours after initial presentation. Monitoring daily plasma insulin levels and adjusting treatment on a day-to-day basis in terms of basal glucose infusions provides fewer opportunities for episodic hypoglycemia. Furthermore, it was easier to predict daily glucose requirements and eventual medical clearance based on the plasma levels.

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Section: Discussionmentioning

confidence: 76%

Massive Insulin Overdose Managed by Monitoring Daily Insulin Levels

Mork

Killeen

Patel

et al. 2011

American Journal of Therapeutics

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“…In one study, intentional insulin overdoses were followed in 15 patients over a 10-year period (14). The different kinds of insulin used included NPH, Lente, and regular insulin.…”

Section: Discussionmentioning

confidence: 99%

Lantus Insulin Overdose: A Case Report

Inboriboon

2011

The Journal of Emergency Medicine

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“…This unpredictable nature can be further compounded by the use of both short-and delayed-action insulin, as in our patient. As a result, the relationship between the injected insulin dose, magnitude of hypoglycemia and final outcome is all but straightforward [1,2].…”

Section: Lessons For the Clinical Management Of An Insulin Overdosementioning

confidence: 99%

“…In any case, due to the above factors a fixed prescription of a continuous high concentration glucose (40 %) infusion should not be used and a lower dose continuous infusion of glucose 10 % or 20 % should be preferred, titrated to maintain blood glucose values in the range of 10±12 mol/l (180±215 mg/dl), with additional bolus injections of glucose 40 % as necessary. Blood glucose determinations should be frequent and close attention paid to the possibility of delayed or recurrent hypoglycemia [2], especially if longacting insulin has been injected.…”

Section: Lessons For the Clinical Management Of An Insulin Overdosementioning

confidence: 99%

“…One of the main goals of therapy is to avoid ongoing or recurrent hypoglycemia by the intravenous administration of glucose [1,2]. This strategy is made difficult by the erratic and often delayed absorption of subcutaneously injected insulin, the varying kinetics when different types of insulin are used and the increased likelihood of both immediate and recurrent hypoglycemia in non-diabetic, compared to diabetic, patients [1,2]. Hence, exogenous glucose administration should be carefully titrated on closely monitored blood glucose levels.…”

mentioning

confidence: 99%

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