Severe Hypoglycemia Due to Cryptic Insulin Use in a Bodybuilder

Heidet, Matthieu; Wahab, Abdel; Ebadi, Vahid; Cogne, Yann; Chollet-Xémard, C.; Khellaf, Mehdi

doi:10.1016/j.jemermed.2018.10.030

Cited by 7 publications

(5 citation statements)

References 17 publications

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“…Multiple cases of hypoglycemia in nondiabetic bodybuilders misusing insulin are reported, including one case of hypoglycemic coma. [64][65][66] Harm Reduction Strategies. A reasonable approach includes educating the patient on potential life-threatening hypoglycemic events, assessing a hemoglobin A1c, as well as providing glucometer and testing supplies to those who decline to stop using insulin.…”

Section: Insulinmentioning

confidence: 99%

Harm Reduction in Male Patients Actively Using Anabolic Androgenic Steroids (AAS) and Performance-Enhancing Drugs (PEDs): a Review

2021

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Anabolic androgenic steroid (AAS) and performanceenhancing drug (PED) use is a prevalent medical issue, especially among men, with an estimated 2.9-4 million Americans using AAS in their lifetime. Prior studies of AAS use reveal an association with polycythemia, dyslipidemia, infertility, hypertension, left ventricular hypertrophy, and multiple behavioral disorders. AAS withdrawal syndrome, a state of depression, anhedonia, and sexual dysfunction after discontinuing AAS use, is a common barrier to successful cessation. Clinical resources for these patients and training of physicians on management of the patient using AAS are limited. Many men are hesitant to seek traditional medical care due to fear of judgment and lack of confidence in physician knowledge base regarding AAS. While proposed approaches to weaning patients off AAS are published, guidance on harm reduction for actively using patients remains sparse. Medical education regarding the management of AAS use disorder is paramount to improving care of this currently underserved patient population. Management of these patients must be non-judgmental and focus on patient education, harm reduction, and support for cessation. The approach to harm reduction should be guided by the specific AAS/ PEDs used.

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Section: Insulinmentioning

confidence: 99%

Harm Reduction in Male Patients Actively Using Anabolic Androgenic Steroids (AAS) and Performance-Enhancing Drugs (PEDs): a Review

2021

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“…The misuse of insulins in strength and endurance sports has been previously reported in various sports, especially in bodybuilding, cycling, and weightlifting, among others. ,, The main and most common side effect that is generated using insulin is hypoglycemia, which, in the case of inadequate therapeutic management or lack of professional medical assistance, can potentially lead to coma or even death among athletes …”

Section: Peptides In Dopingmentioning

confidence: 99%

“…25,37,41 The main and most common side effect that is generated using insulin is hypoglycemia, which, in the case of inadequate therapeutic management or lack of professional medical assistance, can potentially lead to coma or even death among athletes. 42 There are very few cases of insulin abuse reported in the literature; however, the problem of insulin abuse may be much more widespread. One study revealed that at least 10% of a physician's 450 regular patients admitted to using insulin and that most of them obtained insulin from diabetic friends.…”

Section: Peptides In Dopingmentioning

confidence: 99%

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Synthetic Peptides in Doping Control: A Powerful Tool for an Analytical Challenge

et al. 2022

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Peptides are very diverse molecules that can participate in a wide variety of biological processes. In this way, peptides are attractive for doping, since these molecules can activate or trigger biological processes that can improve the sports performance of athletes. Peptide molecules are found in the official World Anti-Doping Agency lists, mainly in sections S2, S4, and S5. In most cases, these molecules have a very short half-life in the body and/or are identical to natural molecules in the body, making it difficult to analyze them as performance-enhancing drugs. This article reviews the role of peptides in doping, with special emphasis on the peptides used as reference materials, the pretreatment of samples in biological matrices, the instrumentation, and the validation of analytical methodologies for the analysis of peptides used in doping. The growing need to characterize and quantify these molecules, especially in complex biological matrices, has generated the need to search for robust strategies that allow for obtaining sensitive and conclusive results. In this sense, strategies such as solid phase peptide synthesis (SPPS), seeking to obtain specific peptides, metabolites, or isotopically labeled analogs, is a key tool for adequate quantification of different peptide molecules in biological matrices. This, together with the use of optimal methodologies for sample pretreatment (e.g., SPE or protein precipitation), and for subsequent analysis by high-resolution techniques (mainly hyphenated LC-HRMS techniques), have become the preferred instrumentation to meet the analytical challenge involved in the analysis of peptides in complex matrices.

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“…Improper use of insulin can result in severe hypoglycemia [ 37 ] and increased fat accumulation, elevating the risk of obesity and related diseases [ 38 ]. The technique of abuse is relatively simple: users self-inject short-acting insulin subcutaneously and consume sugar-containing foods and/or drinks to prevent hypoglycemic events before or after workouts [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Metabolic Consequences of Anabolic Steroids, Insulin, and Growth Hormone Abuse in Recreational Bodybuilders: Implications for the World Anti-Doping Agency Passport

Di Girolamo,

Biasinutto,

Mangogna

et al. 2024

Sports Med - Open

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Background Hormonal doping in recreational sports is a public-health concern. The World Anti-Doping Agency (WADA) promoted the creation of the Athlete Biological Passport, aiming to monitor athlete’s biological variables over time to facilitate indirect detection of doping. Detection tests for anabolic androgenic steroids (AAS) and growth hormone (GH) are available while insulin abuse cannot be revealed. We have determined in recreational bodybuilders the metabolic effects associated with different patterns of hormone abuse. All analyses were conducted using Statistical Package for Social Sciences (SPSS) 21.0 software (SPSS Chicago, IL). Results We have assessed plasma concentrations of selected metabolic markers and fatty acid content in erythrocyte membranes of 92 male bodybuilders and in 45 healthy controls. Hormonal abuse was identified by anonymous questionnaires. 43% (%) of recruited bodybuilders regularly abused hormones, i.e., anabolic androgenic steroids (95%) often associated with GH (30%) and/or insulin (38%). HDL-cholesterol was lower in insulin and/or GH abusers. Alanine (ALT) and aspartic (AST) transaminases were greater in hormone abusing bodybuilders than in non-doping bodybuilders and controls. Insulin doping was selectively associated with increased plasma ALT-to-AST ratio. In erythrocyte membranes, elongase activity (i.e., stearic-to-palmitic ratio) was lower in insulin and/or growth hormone doping, whereas increased Δ-9 desaturase activity (i.e., palmitoleic-to-palmitic ratio) was selectively associated with insulin doping. Conclusions In conclusion, our study demonstrates that insulin and GH abuse are characterized by multiple alterations of specific metabolic markers. Although further studies are needed to test whether longitudinal monitoring of selected metabolic marker such as muscle contraction time, HDL levels, ALT-AST ratio as well as the activities of selected enzymes (e.g. Δ-9 desaturase and elongase), could contribute to the detection of insulin and GH abuse in sport.

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Severe Hypoglycemia Due to Cryptic Insulin Use in a Bodybuilder

Cited by 7 publications

References 17 publications

Harm Reduction in Male Patients Actively Using Anabolic Androgenic Steroids (AAS) and Performance-Enhancing Drugs (PEDs): a Review

Harm Reduction in Male Patients Actively Using Anabolic Androgenic Steroids (AAS) and Performance-Enhancing Drugs (PEDs): a Review

Synthetic Peptides in Doping Control: A Powerful Tool for an Analytical Challenge

Metabolic Consequences of Anabolic Steroids, Insulin, and Growth Hormone Abuse in Recreational Bodybuilders: Implications for the World Anti-Doping Agency Passport

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