Citation

Hsu WH, Liu WC. Journal of Internal Medicine of Taiwan 2021; 32(5): 363-372.

Copyright

(Copyright © 2021)

DOI

10.6314/JIMT.202110_32(5).08

PMID

unavailable

Abstract

Intentional insulin overdose is uncommon in clinical practice. We report a man who attempted to commit suicide with NovoMix®30 insulin. The 55-year-old man was diagnosed with type 2 DM and hepatitis C. He injected himself with 480 to 600 units of premixed insulin (NovoMix®30) subcutaneously in the right lower abdomen between 8PM and 9PM after a quarrel with his family. Two to three hours later, ambulance staff found him with low blood sugar of 53 mg/dL. D50W (50% dextrose) 40 CC was given intravenously. At the emergency department, blood sugar was measured at 95 mg/dL. D10W (10% dextrose) was supplemented at a rate of 60 CC per hour intravenously. Potassium was supplemented due to hypokalemia (2.6 meq/L). One hour later, finger sugar was 61 mg/dL. Additional bolus of glucose was given. Dextrose was titrated up to D10W 100 CC per hour. He recovered well and tolerated oral intake. Over the next 30 hours, five episodes of blood glucose less than 100 mg/dL occurred and 40 CC D50W of bolus was given each time. Laboratory data showed lactic acidosis, hypokalemia, hypophosphatemia, a very high insulin level of 3946.3 mU/L and low C-peptide of 0.43 ng/mL. The last episode of hypoglycemia (58 mg/dL) was observed at 5AM on the 2ndday, upon the 33rdhour after insulin injection. Usual insulin doses were used for diabetes control after resolution of hypoglycemia. He was referred to a psychiatrist for further evaluation. © 2021 Society of Internal Medicine of Taiwan. All rights reserved.

Language: zh

Keywords

adult; human; suicide; male; case report; treatment outcome; drug overdose; clinical article; middle aged; patient referral; emergency ward; hepatitis C; glucose blood level; glucose; C peptide; hypoglycemia; potassium; non insulin dependent diabetes mellitus; lactic acidosis; hypophosphatemia; Article; hypokalemia; patient assessment; supplementation; diabetes control; family conflict; insulin aspart; insulin level