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Insulin glargine is a long acting novel recombinant human insulin analogue indicated to improve glycemic control, in adults and children with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. The time course of action of insulins including insulin glargine may vary between individuals and/or within the same individual. Insulin glargine is given as a 24-h dosing regimen and has no documented half-life or peak effect. Hypoglycemia is the most common adverse effect of insulin, including insulin glargine. As with all insulins, the timing of hypoglycemia may differ among various insulin formulations. We present a case of a 76-year-old male insulin-dependent diabetic patient with refractory hypoglycemia secondary to an intentional overdose of insulin glargine. We would like to highlight the necessity of prolonging IV glucose infusion, for a much longer period than expected from pharmacokinetic properties of these insulin analogues after intentional massive overdose.

OBJECTIVE: One of the major causes of emergency department (ED) visits is acute poisoning. Acute intoxications occur soon after either single or multiple exposures to toxic substances, and they started to be a more serious problem in developing countries. The objective of this study was to investigate the local patterns of acute intoxications, as well as clinical and sociodemographic characteristics of patients with acute poisoning, admitted to our hospital’s ED. METHODS: This single-center, retrospective study was conducted using medical records of consecutive patients admitted to the ED between January 2016 and December 2017. RESULTS: A total of 1344 patients were included in the statistical analysis. Of these, 673 (50.1%) were female. Mean (±SD) age was 32.2 (±12.0), ranging between 17 and 84 years. The highest number of poisoning cases was observed in summer, especially in July (10.0%) and August (11.8%), whereas lowest number of admissions related to poisoning occurred during winter in November (5.1%) and December (5.2%). Among admitted cases, many were suicide attempts (55.7%) followed by non-intentional (accidental) ingestion of non-pharmaceutical (n=553, 41.2%) and pharmaceutical agents (n=42, 3.1%). Single agents were the most common cause of acute intoxications (63.2%) rather than multidrug intoxications. Most frequently observed causes of poisonings were recreational substances (30.0%) and agents exposed by inhalation (13.2%). INR, lactate, and pH levels at admission were significant predictors of 7-day mortality without a significant paired difference between each other. The AUCs for each were 0.89 (SE 0.04; p<0.0001), 0.84 (SE 0.10; p=0.0007), and 0.79 (SE 0.11; p=0.0102), respectively. CONCLUSION: We conclude that recreational substances and medicinal drug intoxications were the leading cause of acute poisonings in our region, occurring mostly during the summer.

Objectives: Various levels of dysfunction and damage can occur in the central nervous system of patients experiencing seizures. It is known that these impairments can be assessed by measurement of biochemical markers. S100B proteins have been extensively studied in recent years. We have assessed whether there is a change in serum S100B protein levels during seizures which lead to cerebral hypoperfusion and/or hypoxia.Patients and Methods: A total of 56 patients admitted to an emergency service due to seizures and more than 18 years of age were included in the study. The control group consisted of 20 patients who were admitted to the emergency service due to complaints other than seizures.Results: There was a significant difference between the groups in terms of gender, hemoglobin levels and S100B levels, whereas there was no significant difference in terms of glucose, sodium and potassium levels. The S100B levels were significantly lower in the patient group compared to the control group. Hemoglobin levels was significantly lower in the control group compared to the patient group.Conclusion: Serum S100B protein concentration was found to be significantly lower in patients compared to controls.

Objective: In this study, we investigated the possible effect of ∆ 9 -tetrahydrocannabinol (THC), a peroxisome proliferator-activated receptor gamma (PPARγ) agonist, on metabolic control and vascular complications of diabetes in streptozotocin/nicotinamide (STZ/NIC) induced type 2 diabetes mellitus. Material and methods: Type 2 diabetes was induced with 65 mg/kg STZ, 15 minute later 85 mg/kg NIC was given intraperitoneally (i.p.) to rats. Three days after diabetes induction, THC (3 mg/kg/day, i.p.) was given for 7 days to diabetic rats. Body weight and plasma glucose levels of rats were measured in all groups before and at the end of 3 weeks after diabetes induction. Acetylcholine (Ach) and sodium nitroprusside (SNP) potency and maximum relaxant effects were calculated on aortic rings pre-contracted with noradrenaline (NA). Results: At the end of 3 weeks, blood glucose levels of diabetic group significantly increased in comparison with the control group. Increased plasma glucose levels were significantly decreased by the treatment of THC. Ach induced relaxation was impaired whereas endotheliumindependent relaxation to SNP was unaffected on isolated diabetic rat aorta. THC treatment enhanced Ach induced relaxation on diabetic rat aortas. Discussion: These results suggested that THC improved endothelium-dependent relaxation in STZ/NIC induced diabetic rat aorta and that these effects were mediated at least in part, by control of hyperglycemia and enhanced endothelial nitric oxide bioavailability.Keywords: rat, aorta, ∆ 9 -tetrahydrocannabinol, type 2 diabetes mellitus, STZ/NIC induced diabetes, endothelial dysfunction Type 2 diabetes mellitus comprises an array of dysfunctions resulting from the combination of resistance to insulin and inadequate insulin secretion. These disorders are characterized by hyperglycemia and associated with microvascular and macrovascular complications. In both diabetic patients and animal models, endothelial dysfunction is asserted to have a key role in the progression of macro-and microangiopathy (5, 33).The most psychoactive substance in cannabis is ∆ 9 -tetrahydrocannabinol (THC) and its derivatives have recently taken interest for researchers because of the possible therapeutic use in diabetes. Although the evidence regarding the effects of cannabis on diabetes is complex, ranging from anecdotal reports on benefits and harms to experimental research on