Citation

Droste J, Hundia V, Pettit A, Narayan N, Nejim A. Practical Diabetes 2012; 29(6): 243-245.

Copyright

(Copyright © 2012)

DOI

10.1002/pdi.1698

PMID

unavailable

Abstract

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.

Language: en

Keywords

adult; human; male; case report; suicide attempt; drug overdose; insulin glargine; article; drug intoxication; glucose blood level; injection site; glucose; insulin; insulin blood level; potassium; insulin dependent diabetes mellitus; wound healing; Insulin overdose; insulin hypoglycemia; local anesthesia; subcutaneous tissue; Hypoglycaemia; Insulin analogue; insulin aspart; glucose infusion; suture; excision; abdominal wall; Surgical excision