Massive intentional insulin overdose

Barton, Helena; Hendy, Philip; Evans, A. M.

doi:10.1002/pdi.1546

Cited by 4 publications

(7 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Overdose attempts with insulin analogues have been reported since 2004 6–14. The initial treatment in all cases was the reversal of the hypo‐glycaemia with intravenous glucose 6–14.…”

Section: Discussionmentioning

confidence: 99%

“…Overdose attempts with insulin analogues have been reported since 2004 6–14. The initial treatment in all cases was the reversal of the hypo‐glycaemia with intravenous glucose 6–14. The length of intravenous glucose administration in insulin analogue overdoses ranged from 48–130 hours 6–14.…”

Section: Discussionmentioning

confidence: 99%

“…The initial treatment in all cases was the reversal of the hypo‐glycaemia with intravenous glucose 6–14. The length of intravenous glucose administration in insulin analogue overdoses ranged from 48–130 hours 6–14. This could be explained by a ‘depot effect’ with delayed absorption from the injection site, as observed in conventional insulin overdoses 15…”

Section: Discussionmentioning

confidence: 99%

“…The main stem of treatment of hypoglycaemia due to an insulin overdose should initially be intravenous glucose in sufficiently high doses as described in all case reports 6–19. Electrolyte disturbances need to be addressed as required and the patient should to be closely monitored 4.…”

Section: Discussionmentioning

confidence: 99%

“…Insulin overdoses are infrequent, but can lead to serious harm to patients including neurological complications, electrolyte disturbances, acute hepatic injury, respiratory failure and death 1–6. Several case reports of overdoses with insulin analogues have been published 6–14. An overdose with conventional insulin or insulin analogues can cause refractory hypoglycaemia, requiring glucose infusion for several days and a prolonged hospital stay 1,2,4–15…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Excision of injection site substantially reduced serum insulin concentration in a potentially life‐threatening insulin analogue overdose

et al. 2012

View full text Add to dashboard Cite

Since the introduction of insulin analogues, there have been several published case reports of overdoses with this medication. Refractory hypoglycaemia with potentially serious neurological sequelae, including death, can occur in severe insulin overdoses. Around 30 years ago, long before insulin analogues were available, several authors reported that the excision of the soft tissue at the injection site lowered plasma insulin concentrations in overdoses with conventional short‐acting and depot insulin. In a suicide attempt, an 18‐year‐old man had injected himself with a large amount of insulin analogues into the abdominal wall; 50 minutes after the overdose he became hypoglycaemic. He was commenced on an intravenous infusion of glucose and the injection site was surgically excised. Serial serum insulin concentrations were measured. After the excision of the insulin injection site, serum insulin concentrations fell from 4220 to 88pmol/L within 2.5 hours. Those results were only available after several weeks. As a precaution at the time, the glucose infusion had been continued for 67 hours. We observed the last hypoglycaemic event in our patient a few minutes after the surgical intervention. The patient suffered no complications and was discharged following a psychiatric assessment. In retrospect, with the knowledge that our patient's serum insulin concentrations had dramatically fallen after surgical intervention, intravenous glucose could have been stopped earlier. This case report describes a substantial reduction in serum insulin concentrations using surgical excision of the single injection site after a severe overdose of insulin glargine and insulin aspart. Copyright © 2012 John Wiley & Sons.

show abstract

“…Overdose attempts with insulin analogues have been reported since 2004 6–14. The initial treatment in all cases was the reversal of the hypo‐glycaemia with intravenous glucose 6–14.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Excision of injection site substantially reduced serum insulin concentration in a potentially life‐threatening insulin analogue overdose

et al. 2012

View full text Add to dashboard Cite

show abstract

Massive Levemir (Long-Acting) Insulin Overdose: Case Report

Oduru

Ahmad

2012

Case Reports in Medicine

View full text Add to dashboard Cite

A 52-year-old insulin-dependant diabetic man presented to the Emergency Department 2 hours after a deliberate massive overdose of 2100 units of long-acting Levemir insulin and a large quantity of whisky. On initial assessment, his GCS was 3/15 and his capillary blood sugar was 2.6 mmol/L. The patient was given a 50 ml bolus of 50% dextrose, followed by intravenous infusions of both 5% and 10% dextrose. Despite the continuous infusions, he experienced 4 symptomatic hypoglycaemic episodes in the first 12 hours after admission. These were managed with oral glucose, IM glucagon, and further dextrose boluses. Blood electrolytes and pH were monitored throughout. Insulin overdoses are relatively common and often occur with an excess of other drugs or alcohol which can enhance its action. Overdoses can result in persistent hypoglycaemia, liver enzyme derangement, electrolyte abnormalities, and neurological damage. Overall mortality is 2.7% with prognosis poorest in patients who are admitted with decreased Glasgow Coma scale (GCS) 12 hours after overdose.

show abstract

Prolonged Severe Hypoglycemia in a Pediatric Patient With Type 1 Diabetes

Paz

Vaidyanathan

2018

Clinical Diabetes

View full text Add to dashboard Cite

Massive intentional insulin overdose

Cited by 4 publications

References 5 publications

Excision of injection site substantially reduced serum insulin concentration in a potentially life‐threatening insulin analogue overdose

Excision of injection site substantially reduced serum insulin concentration in a potentially life‐threatening insulin analogue overdose

Massive Levemir (Long-Acting) Insulin Overdose: Case Report

Prolonged Severe Hypoglycemia in a Pediatric Patient With Type 1 Diabetes

Contact Info

Product

Resources

About