Prolonged Hypoglycemic Effect Due to Intentional Massive Insulin Glargine Overdose

Abstract Introduction: Since its discovery in 1921, insulin has served as the mainstay of treatment for patients with both type 1 and insulin-dependent 2 diabetes mellitus (T2DM). Insulin is available long short acting formulations. Glargine, a long-acting insulin, an onset action one to two hours length duration 24 hours. Although generally well tolerated, when taken overdose, can lead severe hypoglycemia, seizures, unconsciousness, or even death. We present case male refractory hypoglycemia after intentional glargine overdose. Case: A 57-year-old man past medical history T2DM, alcohol abuse, cirrhosis, depression, presented hospital suicide attempt. The patient reported that night drinking he experienced suicidal thoughts injected himself 8 vials 100 Units (800 units) glargine. On initial presentation, had GCS 15/15 was slight distress. remainder his exam normal. Initial laboratory workup pertinent blood glucose 86mg/dL. Poison control contacted started on intravenous infusion 10% Dextrose checks every 15 minutes; subsequently reduced 60 minutes. Despite continuous administration, still suffered from hypoglycemic episodes (glucose < 70mg/dL) requiring boluses first 96 hospitalization. His transitioned D5 then discontinued. Psychiatry determined no longer risk outpatient therapy warranted. controlled not discharged insulin. Discussion: human analogue prolonged activity profile pronounced peak. At doses between 0.4 IU/kg 0.8 IU/kg, metabolized However, cases effects absorption are highly variable. Multiple studies have illustrated unusual effect massive doses. mechanism behind this unclear but several factors may result action. Larger injection volumes create larger depot mechanical microcirculation leading delayed absorption. Presence lipodystrophy repeated injection, hepatic impairment, renal impairment also alter kinetics. Another contributing factor our obesity, which associated Conclusion: overdose due altered pharmacokinetics. Physicians should be cognizant about closely monitor levels anticipate possibility IV dextrose infusion.