Lantus Insulin Overdose: A Case Report

Lu, Michael T.; Inboriboon, Pholaphat Charles

doi:10.1016/j.jemermed.2010.04.007

Cited by 34 publications

(34 citation statements)

References 22 publications

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“…This can be followed by infusion of D5W or D10W at a rate maintaining serum glucose above 100 mg/dL in certain circumstances. Repeat bedside glucose determination should be performed every 30 min for the first two hours, to detect RH 8,80,81. Glucose replacement should be given intravenously in patients treated with α-glucosidase inhibitors.…”

Section: Overviewmentioning

confidence: 99%

Hypoglycemia Revisited in the Acute Care Setting

et al. 2011

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Hypoglycemia is a common finding in both daily clinical practice and acute care settings. The causes of severe hypoglycemia (SH) are multi-factorial and the major etiologies are iatrogenic, infectious diseases with sepsis and tumor or autoimmune diseases. With the advent of aggressive lowering of HbA1c values to achieve optimal glycemic control, patients are at increased risk of hypoglycemic episodes. Iatrogenic hypoglycemia can cause recurrent morbidity, sometime irreversible neurologic complications and even death, and further preclude maintenance of euglycemia over a lifetime of diabetes. Recent studies have shown that hypoglycemia is associated with adverse outcomes in many acute illnesses. In addition, hypoglycemia is associated with increased mortality among elderly and non-diabetic hospitalized patients. Clinicians should have high clinical suspicion of subtle symptoms of hypoglycemia and provide prompt treatment. Clinicians should know that hypoglycemia is associated with considerable adverse outcomes in many acute critical illnesses. In order to reduce hypoglycemia-associated morbidity and mortality, timely health education programs and close monitoring should be applied to those diabetic patients presenting to the Emergency Department with SH. ED disposition strategies should be further validated and justified to achieve balance between the benefits of euglycemia and the risks of SH. We discuss relevant issues regarding hypoglycemia in emergency and critical care settings.

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Section: Overviewmentioning

confidence: 99%

Hypoglycemia Revisited in the Acute Care Setting

et al. 2011

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“…[373839] Not only regular insulin, but its congeners like insulin glargine and lispro have also been used for self-harm attempt. [40414243] Use of insulin as a means of suicidal attempt seems to be more common in patients with T1DM than T2DM. [44] This could be due to the fact that T1DM can only be treated with insulin and consequently is more regularly accessible to these patients.…”

Section: Introductionmentioning

confidence: 99%

Diabetes mellitus and suicide

Sarkar

Balhara

2014

Indian J Endocr Metab

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Relationship of diabetes mellitus (DM) with metal health disorders such as depression has been explored extensively in the published literatures. However, association of diabetes mellitus with suicidal tendencies has been evaluated less extensively. The present narrative review aimed to assess the literature relating to diabetes mellitus and suicide. As a part of the review, Pubmed and Google Scholar databases were searched for English language peer reviewed published studies with keywords relating to diabetes and suicide. Additional references were identified using cross-references. The available literature suggests that suicidal ideas and attempts are more frequent in patients with diabetes mellitus than healthy or medically ill controls. Although, a few studies report evidence to the contrary. Suicide accounts for a large proportion of deaths in patients with diabetes mellitus type I (T1DM), and their mortality rate is higher than that of age matched control population. Psychological morbidity, including depression, precedes suicidal ideas and attempts; though many other factors can be hypothesized to impact and modulate this association. A common method of suicide attempt in patients with diabetes includes uses of high doses of insulin and its congeners or medications to treat the disease. Regular screening and prompt treatment of depression and suicidality is suggested for patients with DM.

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“…The tendency of insulin glargine to form hexamers and the addition of zinc also serve to extend absorption time (11). It is precisely due to these properties that subcutaneous overdoses of insulin glargine are reported to cause prolonged hypoglycemia, frequently requiring large doses of parenteral glucose (2)(3)(4)(5)(6)(7)(8). In one report, hypoglycemia was noted 106 h after overdose of 1000 units of insulin glargine (7).…”

Section: Discussionmentioning

confidence: 99%

“…It has an extended duration of action (>24 h) and no measurable peak effect (1). It is due to this long duration of action that overdoses of insulin glargine can be problematic, often requiring hospital admissions and prolonged treatment (2)(3)(4)(5)(6)(7)(8). All prior reports of insulin glargine overdoses and toxicity have concerned exposure via the subcutaneous route.…”

Section: Introductionmentioning

confidence: 99%