Problem Based Review: The patient who has taken an overdose of long-acting insulin analogue

Abstract

Insulin overdose can cause harm due to hypoglycaemia, effects on electrolytes and acute hepatic injury. The established long-acting insulin analogue preparations (detemir and glargine) can present specific management problems because, in overdose, their effects are extremely prolonged, often lasting 48-96 hours. The primary treatment is continuous intravenous 10% or 20% glucose infusion with frequent capillary blood glucose monitoring. Surgical excision of the insulin injection site has been used successfully, even days after the overdose occurred. Once the effects of overdose have receded, diabetes treatment must be restarted with care, especially in patients with type 1 diabetes. Monitoring serum insulin concentration has been successfully used to predict when the effects of the overdose will cease.

Treatment of insulin poisoning: A 100‐year review

“…Corticosteroids may also induce insulin resistance and so mitigate the effects of high insulin concentrations. 42,48 They will, however, exacerbate hypokalaemia, have been little used, and are of unproven benefit.…”

“…Corticosteroids, which were used occasionally, had initially been proposed to treat cerebral oedema that prolonged unconsciousness after hypoglycaemia had resolved. Corticosteroids may also induce insulin resistance and so mitigate the effects of high insulin concentrations 42,48 . They will, however, exacerbate hypokalaemia, have been little used, and are of unproven benefit.…”

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.…”