The Other Face of Insulin—Overdose and Its Effects

Abstract

Insulin is the most effective glycemic-lowering drug, and for people suffering from type 1 diabetes it is a life-saving drug. Its self-dosing by patients may be associated with a higher risk of overdose, both accidental and deliberate. Insulin-induced hypoglycemia causes up to 100,000 emergency department calls per year. Cases of suicide attempts using insulin have been described in the literature since its introduction into therapy, and one of the important factors in their occurrence is the very fact of chronic disease. Up to 90% of patients who go to toxicology wards overdose insulin consciously. Patients with diabetes are burdened with a 2–3 times higher risk of developing depression compared to the general population. For this reason, it is necessary to develop an effective system for detecting a predisposition to overdose, including the assessment of the first symptoms of depression in patients with diabetes. A key role is played by a risk-conscious therapeutic team, as well as education. Further post-mortem testing is also needed for material collection and storage, as well as standardization of analytical methods and interpretation of results, which would allow for more effective detection and analysis of intentional overdose—both by the patient and for criminal purposes.

Insulin and Oral Hypoglycemic Drug Overdose in Post-Mortem Investigations: A Literature Review

“…Peripheral blood glucose concentrations drop around 1–2 mmol/L per hour, and in central blood samples, glucose concentration may be increased by enzymatic breakdown of hepatic glycogen, which then gets transferred into large vessels [ 52 ]. Generally, a glucose concentration of less than 200 mg/dL in postmortem peripheral blood samples is considered normal [ 53 ].…”

“…Injection sites serve as a reservoir where traces of unabsorbed insulin may be found even days after the injection. This persistence obviously depends on the dose, type of insulin, and other factors [ 33 , 52 ]. Attention must be paid to diabetic patients, with whom a positive result of this kind of investigation can only determine if the type of insulin is the one prescribed to the subject or not [ 57 ].…”

Immunohistochemical detection of insulin at the injection site in a case of suspected murder with the suicide of the perpetrator

“…In medicolegal practice, rare cases involving suicidal, criminal, or accidental insulin overdose are both analytically and forensically challenging [1]. In each of these cases, it is crucial to obtain preliminary information from the prosecutor or the police prior to forensic autopsy in order to allow for proper macroscopic examination and targeted post-mortem diagnosis [2].…”

Biochemical Toxicological Study of Insulin Overdose in Rats: A Forensic Perspective

“…Insulin is the most common drug used in the clinical treatment of diabetes [ 3 ], so insulin overdose is mostly an accidental treatment for diabetic patients, including the miscalculation of dosage and incorrect use of insulin specifications [ 1 , 5 , 6 , 7 ]. An insulin overdose can lead to hypoglycemia, with blood glucose levels below 3.9 mmol/L (70 mg/dL) defined as clinical hypoglycemia and blood glucose levels below 3 mmol/L (54 mg/dL) defined as clinically important hypoglycemia [ 7 , 8 , 9 ].…”

“…Insulin is the most common drug used in the clinical treatment of diabetes [ 3 ], so insulin overdose is mostly an accidental treatment for diabetic patients, including the miscalculation of dosage and incorrect use of insulin specifications [ 1 , 5 , 6 , 7 ]. An insulin overdose can lead to hypoglycemia, with blood glucose levels below 3.9 mmol/L (70 mg/dL) defined as clinical hypoglycemia and blood glucose levels below 3 mmol/L (54 mg/dL) defined as clinically important hypoglycemia [ 7 , 8 , 9 ]. The clinical symptoms of hypoglycemia can be summarized into the following two aspects: sympathetic hyperactivity, including sweating, hunger, palpitation, and brain dysfunction, including confusion, drowsiness, impaired coordination, visual impairment, paresthesia, serious convulsions, coma, and even death [ 5 , 6 , 8 , 9 , 10 ].…”