Prediction of recovery time from hypoglycemia in patients with insulin overdose

Ohyama, Tetsuo; Saisho, Yoshifumi; Muraki, Ayako; Kawai, Takeshi; Itoh, Hiroshi

doi:10.1507/endocrj.k11e-018

Cited by 15 publications

(19 citation statements)

References 8 publications

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“…The onset of hypoglycaemia can be as soon as 1–2 h or be delayed over 18 h after insulin glargine overdose . Duration of action may be prolonged a few days to a week after an overdose and larger doses have been associated with longer duration, but not the type of insulin . This may be due to changed absorption profiles of even short‐acting insulin due to large injection depots.…”

Section: Pharmacology and Toxicologymentioning

confidence: 99%

Treatment of sulfonylurea and insulin overdose

Klein‐Schwartz

Stassinos

Isbister

2016

Brit J Clinical Pharma

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The most common toxicity associated with sulfonylureas and insulin is hypoglycaemia. The article reviews existing evidence to better guide hypoglycaemia management. Sulfonylureas and insulin have narrow therapeutic indices. Small doses can cause hypoglycaemia, which may be delayed and persistent. All children and adults with intentional overdoses need to be referred for medical assessment and treatment. Unintentional supratherapeutic ingestions can be initially managed at home but if symptomatic or if there is persistent hypoglycaemia require medical referral. Patients often require intensive care and prolonged observation periods. Blood glucose concentrations should be assessed frequently. Asymptomatic children with unintentional sulfonylurea ingestions should be observed for 12 h, except if this would lead to discharge at night when they should be kept until the morning. Prophylactic intravenous dextrose is not recommended. The goal of therapy is to restore and maintain euglycaemia for the duration of the drug's toxic effect. Enteral feeding is recommended in patients who are alert and able to tolerate oral intake. Once insulin or sulfonylurea-induced hypoglycaemia has developed, it should be initially treated with an intravenous dextrose bolus. Following this the mainstay of therapy for insulin-induced hypoglycaemia is intravenous dextrose infusion to maintain the blood glucose concentration between 5.5 and 11 mmol l -1 . After sulfonylurea-induced hypoglycaemia is initially corrected with intravenous dextrose, the main treatment is octreotide which is administered to prevent insulin secretion and maintain euglycaemia. The observation period varies depending on drug, product formulation and dose. A general guideline is to observe for 12 h after discontinuation of intravenous dextrose and, if applicable, octreotide.

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Section: Pharmacology and Toxicologymentioning

confidence: 99%

Treatment of sulfonylurea and insulin overdose

Klein‐Schwartz

Stassinos

Isbister

2016

Brit J Clinical Pharma

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“…A recent study showed a positive correlation between recovery time from hypoglycaemia and insulin dose . The prolonged half‐life of insulin resulting from overdose is assumed to be caused by delayed absorption of injected insulin from subcutaneous tissue due to local hypo‐circulation resulting from mechanistic pressure, and occupation of insulin receptors by exogenous insulin . In addition, the distinct absorption mechanism of IDeg might have contributed to the long‐lasting hypoglycaemia in the present case.…”

Section: Discussionmentioning

confidence: 57%

“…Moreover, the IRI resulting from IDeg injection remained in the blood for ~400 h, highlighting the risk of unexpected long‐lasting hypoglycaemia in similar cases. A recent study showed a positive correlation between recovery time from hypoglycaemia and insulin dose . The prolonged half‐life of insulin resulting from overdose is assumed to be caused by delayed absorption of injected insulin from subcutaneous tissue due to local hypo‐circulation resulting from mechanistic pressure, and occupation of insulin receptors by exogenous insulin .…”

Section: Discussionmentioning

confidence: 99%

Insulin degludec overdose may lead to long‐lasting hypoglycaemia through its markedly prolonged half‐life

et al. 2018

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Although the reported half-life of insulin degludec in the body is ~25 h when administered in standard doses (0.4-0.8 units/kg), no study has investigated its half-life after overdose. In the present case, the half-life of insulin degludec was ~1.6 times longer than that observed with standard doses, probably leading to long-lasting hypoglycaemia. Physicians should be aware of the possibility of unexpected long-lasting severe hypoglycaemia resulting from insulin degludec overdose.

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“…For example, a 39-year-old non-diabetic woman overdosed on 300 units of subcutaneous lispro insulin and required supplemental glucose for more than 11 hours (3), two times longer than would be expected from the usual pharmacodynamics properties (4). Prolonged hypoglycemia could be due to the cumulative effect of insulin or delayed insulin absorption due to local hypo-perfusion from mechanical pressure (5). Theoretically, very high insulin levels may overwhelm receptor-mediated clearance, especially in the liver, which could result in a prolonged half-life.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, authors such as Ohyama et al have suggested that the duration of hypoglycemia may be better estimated by the total dose of insulin rather than the insulin type (5). Based on a review of 33 Japanese cases of subcutaneous insulin overdose that range from 50 units of regular and premixed insulin to 3000 units of NPH insulin, they report a correlation of recovery time in hours from hypoglycemia (y) and insulin units (x) as y = 0.045x (r = 0.88, p < 0.001), and with cases of less than 1500 units of subcutaneous insulin, y = 0.062x (r = 0.88, p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Peripheral IV Insulin Infusion Infiltration Presenting as “Insulin Resistance”

Kim

Woeber

MacMaster

et al. 2016

Critical Care Medicine

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Objective We present the case of a 66-year-old woman who developed hypoglycemia following the prolonged infiltration of a high dose continuous peripheral intravenous insulin infusion. Study Selection Case report. Data Synthesis The patient was post-lung transplantation and was receiving high doses of glucocorticoids. Despite increasing the peripheral intravenous insulin rate, hyperglycemia persisted. We discovered that the intravenous insulin infusion line infiltrated, resulting in a large subcutaneous insulin depot, estimated to be 450 units of regular insulin. She subsequently experienced prolonged hypoglycemia that was managed with concentrated dextrose containing fluids. In our literature search, there were no similar case reports. The literature on insulin overdose, usually from suicide attempts, can help guide the management of iatrogenic hyperinsulinemic hypoglycemia. Important management considerations include anticipated duration of hypoglycemia, supplemental glucose, fluid management, and electrolyte monitoring. Conclusion Peripheral intravenous insulin infusion infiltration should be considered when patients do not respond to increasing rates of insulin infusion.

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Prediction of recovery time from hypoglycemia in patients with insulin overdose

Cited by 15 publications

References 8 publications

Treatment of sulfonylurea and insulin overdose

Treatment of sulfonylurea and insulin overdose

Insulin degludec overdose may lead to long‐lasting hypoglycaemia through its markedly prolonged half‐life

Peripheral IV Insulin Infusion Infiltration Presenting as “Insulin Resistance”

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