Long acting insulin glargine overdose, a surprising long lifetime

Abstract

A 57-year-old woman was found at home in quiet coma secondary to a deliberate insulin glargine injection. Due to the persistent hypoglycemia, she was referred to the ICU where she remained hypoglycemic for seven days. The patient presented recurrent episodes of hypoglycemia, even after day 7 and she received a total of 587 g of dextrose. Few data are available concerning the management of intoxication by long-lasting insulin. Our case illustrates the critical importance of admitting such patients in ICU for both close monitoring of blood sugar and dextrose administration. We discuss the discrepancy between the in vitro half-life of the insulin and the actual half-life with a "reservoir effect". Eventually, we compare our case with the casestudies in the literature and summarize the review of those published cases.

Toward once-monthly insulin therapy via synergy in two pharmacokinetic protractors: Fc-conjugation and fatty acid acylation

“…While the benefits have been listed above, a significant concern with this type of profile is the risk associated with potential overdose and hypoglycemia. 46,47 Counteracting such a long-acting insulin with glucose might prove to be extremely difficult and would require intensive and persistent medical intervention. Considering this, additional safety mechanisms could be considered.…”