Insulin &amp; C-peptide levels in sulfonylurea-induced hypoglycemia: A systematic review

DeWitt, Chris; Heard, Kennon; Waksman, Javier C.

doi:10.1007/bf03160920

Cited by 8 publications

(7 citation statements)

References 42 publications

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Section: Discussionmentioning

confidence: 99%

“…When endogenous insulin is released from the pancreas, equimolar amounts of the C-peptide are released simultaneously, and the C-peptide is metabolized and cleared more slowly than insulin, so the C-peptide can be used to assess the level of endogenous insulin secretion [ 55 , 56 , 57 ]. In the normal body, the ratio of insulin to C-peptide (I:C) is less than 1 [ 55 ]. When hyperinsulinemia occurs, such as pancreatic β-cell tumors and the rare insulin autoimmune syndrome, the insulin level and C-peptide level increase simultaneously, and the ratio of insulin to C-peptide (I:C) is still less than one [ 55 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the normal body, the ratio of insulin to C-peptide (I:C) is less than 1 [ 55 ]. When hyperinsulinemia occurs, such as pancreatic β-cell tumors and the rare insulin autoimmune syndrome, the insulin level and C-peptide level increase simultaneously, and the ratio of insulin to C-peptide (I:C) is still less than one [ 55 , 58 ]. However, when exogenous insulin is injected into the body, endogenous insulin secretion is inhibited, resulting in a decrease in the C-peptide level, and the ratio of the insulin level to C-peptide (I:C) is greater than one [ 55 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

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Biochemical Toxicological Study of Insulin Overdose in Rats: A Forensic Perspective

Bian,

He,

Wang

et al. 2023

Toxics

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Due to nonspecific pathological changes and the rapid degradation of insulin in postmortem blood samples, the identification of the cause of death during insulin overdose has always been a difficulty in forensic medicine. At present, there is a lack of studies on the toxicological changes and related mechanisms of an insulin overdose, and the specific molecular markers of insulin overdose are still unclear. In this study, an animal model of insulin overdose was established, and 24 SD rats were randomly divided into a control group, insulin overdose group, and a recovery group (n = 8). We detected the biochemical changes and analyzed the toxicological mechanism of an insulin overdose. The results showed that after insulin overdose, the rats developed irregular convulsions, Eclampsia, Opisthotonos, and other symptoms. The levels of glucose, glycogen, and C-peptide in the body decreased significantly, while the levels of lactate, insulin, and glucagon increased significantly. The decrease in plasma K+ was accompanied by the increase in skeletal muscle K+. The PI3K-AKT signaling pathway was significantly activated in skeletal muscle, and the translocation of GLUT4/Na+-K+-ATPase to sarcolemma was significantly increased. Rare glycogenic hepatopathy occurred in the recovery group after insulin overdose. Our study showed that insulin overdose also plays a role in skeletal muscle cells, mainly through the PI3K-Akt signaling pathway. Therefore, the detection of signaling pathway proteins of the skeletal muscle cell membrane GLUT4 and Na+-K+-ATPase has a certain auxiliary diagnostic value for forensic insulin overdose identification. Glycogen detection in the liver and skeletal muscle is important for the diagnosis of insulin overdose, but it still needs to be differentiated from other causes of death. Skeletal muscle has great potential for insulin detection, and the ratio of insulin to the C-peptide (I:C) can determine whether an exogenous insulin overdose is present.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Biochemical Toxicological Study of Insulin Overdose in Rats: A Forensic Perspective

Bian,

He,

Wang

et al. 2023

Toxics

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“…Quadrani et al reported on 93 children (mean age, 3.5 (from 1 to 16) years) who were each given an overdose of SU by a parent suffering from Münchausen syndrome [6]. The remaining 3 reports did not give detailed information on the suicide attempts, but included patients who had self-destructive habits, psychiatric disorders (including Münchausen syndrome), or caregivers with Münchausen syndrome and were given an overdose of SU intentionally [7][8][9].…”

Section: Discussionmentioning

confidence: 99%

Suicide attempt by an overdose of sitagliptin, an oral hypoglycemic agent: A case report and a review of the literature

et al. 2012

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DipeptiDyl peptiDase-4 (Dpp-4) inhibitors have recently been approved worldwide for the management of diabetes. Although insulin is a wellknown anti-diabetic agent that is occasionally used for attempting suicide, the effect of an oral overdose of anti-diabetic agents, such as sitagliptin, a DPP-4 inhibitor, remains unclear. The incidence of hypoglycemia across a range of sitagliptin doses (50, 100, and 200 mg) in a 12-week double-blind randomized controlled study in Japanese patients with type 2 diabetes mellitus was as low as 1.3-4.4% [1]. We present a case report of sitagliptin overdose in a suicide attempt. We also review the literature on overdose with oral antidiabetic agents, and highlight the best use of oral anti- abstract. Dipeptidyl peptidase-4 (DPP-4) inhibitors are a newer class of oral hypoglycemic agents for the management of diabetes that elevate the plasma concentration of active glucagon-like peptide-1 via inhibition of DPP-4. They effectively lower not only glycosylated hemoglobin levels, but also fasting and postprandial plasma glucose levels. Patients with diabetes occasionally consume an overdose of oral hypoglycemic agents in suicide attempts: the prevalence of depression is high in patients with diabetes, and depression is a strong risk factor for suicide. We encountered an 86-year-old woman with type 2 diabetes and depression, who was transferred to the emergency room 4h after ingestion of 1,700 mg of the DPP-4 inhibitor sitagliptin (1,700 mg is 17 times greater than the approved maximum dose). Upon arrival, she was fully conscious, plasma glucose was 124 mg/dL, and serum immunoreactive insulin level was 5.81 μU/mL. Thereafter, the plasma concentration of sitagliptin rose to 3,793 nM, which is 4.5 times higher than the value found under regular treatment with the maximum dose. The patient did not suffer from hypoglycemia, suggesting that a single oral overdose of sitagliptin is unlikely to cause hypoglycemia. A literature review of oral anti-diabetic agents revealed that overdose of biguanides is occasionally fatal when immediate intensive care is not provided. In summary, sitagliptin is a good treatment option for diabetic elderly patients or patients with psychiatric disorders who are suicidal and do not require insulin.Key words: Dipeptidyl peptidase-4 inhibitors, Hypoglycemia, Overdose, Sitagliptin diabetic agents in elderly people and in patients with psychiatric disorders. Case ReportAn 86-year-old woman with a 10-year history of type 2 diabetes mellitus was admitted to our hospital after sitagliptin overdose (1,700 mg: 34 tablets, 50 mg each) in a suicide attempt. She had been suffering from depression, and was prescribed sitagliptin 50 mg/day for 10 months; her HbA1c levels were stable at about 7.9% (National Glycohemoglobin Standardization Program). On admission, she was conscious and alert. Her blood pressure was 124/80 mm Hg and body temperature was 36.5°C. Blood glucose and immunoreactive insulin levels were 124 mg/dL and 5.81 μU/mL, respectively. Other laboratory data were a...

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“…[5] Naturally, during the current pandemic, it would be tenable that they should be totally avoided due to the high risk of development of hypoglycemia. [7] The use of sodiumglucose-co-transporter 2 inhibitors (such as canagliflozin, dapagliflozin, and empagliflozin) during Ramadan is controversial, nonetheless they should be avoided due to high risk of development of dehydration, diabetic ketoacidosis, and consequent kidney damages in the context of Covid-19. [1,8,9] As patients with diabetes (particularly the elderly with type 2 diabetes) simultaneously consume anti-hypertensive and lipid lowering medications, dose and timing of these drug may also need to be modified in the context of Covid-19 pandemic.…”

Section: Management Of Patients With Type 2 Diabetesmentioning

confidence: 99%

Diabetes management during Ramadan amid Covid-19 pandemic

2020

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Management of fasting patients with diabetes during Ramadan has always posed a great challenge on clinicians. This year, Ramadan has coincided with the Covid-19 pandemic which per se can complicate diabetes care. Although patients with diabetes should be generally discouraged from fasting, those who insist to fact during the current Covid-19 pandemic should undergo strict risk assessment and receive thorough education. In patients with type 2 diabetes, administered antidiabetics and their dose should be modified to minimize the risk of hypoglycemia and dehydration. In type 1 diabetic patients, insulin dose and it timing should be precisely calculated based on regular and rigorous blood glucose monitoring. Nonetheless, it would be prudent to generally discourage patients with diabetes form fasting this Ramadan to avoid the risk of life-threatening complications such severe dehydration and ensuing kidney damage.

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Insulin & C-peptide levels in sulfonylurea-induced hypoglycemia: A systematic review

Cited by 8 publications

References 42 publications

Biochemical Toxicological Study of Insulin Overdose in Rats: A Forensic Perspective

Biochemical Toxicological Study of Insulin Overdose in Rats: A Forensic Perspective

Suicide attempt by an overdose of sitagliptin, an oral hypoglycemic agent: A case report and a review of the literature

Diabetes management during Ramadan amid Covid-19 pandemic

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