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2.1
Insulin Overdose

Presentation

We present a unique case of insulin glargine overdose that presented with persistent hypoglycemia and required prolonged in-hospital treatment. [ncbi.nlm.nih.gov]

Gastrointestinal

  • Nausea

    Nausea was managed with anti-emetics. Intramuscular and subcutaneous glucagon is effective in the management of refractory and severe hypoglycemia in youth with both T1DM and hyperinsulinism. [ncbi.nlm.nih.gov]

    […] may result if you: take too much insulin excessively exercise, thus use more glucose than normal miss a meal or don’t eat as much as usual, thus ingesting less glucose Symptoms of too much insulin hyperinsulinism may involve: chills hunger fainting nausea [healthblurbs.com]

    Symptoms of an insulin overdose Symptoms include: Depressed mood Dizziness Drowsiness Fatigue Headache Hunger Inability to concentrate Irritability Nausea Nervousness Personality changes Rapid heartbeat Restlessness Sleep disturbances Slurred speech Sweating [diabetes-ayurveda.com]

    These include: Confusion Dizziness Drowsiness Extreme hunger Headache Irritability Mood changes Nausea Nervousness Rapid heartbeat Sleep disturbances Slurred speech Sweating Trembling Trouble concentrating Unsteady movements Severe symptoms of an insulin [diabetescommunity.com]

    Taking insulin when you don't need it causes symptoms such as sweating, shaking, headache, irritability, nervousness, anxiety, weakness, dizziness, hunger, tremors, nausea, and difficulty concentrating or thinking. [livestrong.com]

Neurologic

  • Seizure

    If you're unconscious or too confused or are having seizures, those around you will need to take control. Give your family and friends these instructions: If you lose consciousness, they should call 911 immediately. [webmd.com]

    Police say that can cause seizures or more serious problems. Her mother, 22-year-old Deva Young, of Warren, has been jailed in Cleveland on $15,000 bond. Court records listed no attorney for her. [abc6onyourside.com]

    That level of insulin could cause a child with diabetes to suffer seizures, go into a diabetic coma or die, according to police. Both of her parents had previously been shown how to properly give the girl her medication, police said. [cleveland.com]

    More severe symptoms include: Seizures Loss of consciousness Changes in behavior, such as irritability Loss of coordination Difficulty speaking Confusion Coma Loss of life. You may find that you have your own unique set of low blood sugar symptoms. [diabetes.emedtv.com]

  • Irritability

    Symptoms of hypoglycemia include: Anxiety Confusion Extreme hunger Fatigue Irritability Sweating or clammy skin Trembling hands If sugar levels continue to fall during an insulin overdose, serious medical complications and even death. [nursinghomelawcenter.org]

    More severe symptoms include: Seizures Loss of consciousness Changes in behavior, such as irritability Loss of coordination Difficulty speaking Confusion Coma Loss of life. You may find that you have your own unique set of low blood sugar symptoms. [diabetes.emedtv.com]

    […] too much insulin excessively exercise, thus use more glucose than normal miss a meal or don’t eat as much as usual, thus ingesting less glucose Symptoms of too much insulin hyperinsulinism may involve: chills hunger fainting nausea tremors sweating irritability [healthblurbs.com]

    Symptoms of Insulin overdose (hypoglycaemia) Trembling Sweating Dizziness or light-headedness Nervousness or irritability Behaviour and mood changes Headache Weakness Numbness or tingling around the mouth Pale skin Confusion Extreme hunger Extreme symptoms [sundaytimes.lk]

    Sweating Dizziness Palpitation Tremor Hunger Restlessness Tingling in the hands, feet, lips, or tongue Lightheadedness Decreased concentration Headache Drowsiness Sleep disturbances Anxiety Blurred vision Slurred speech Depressed mood Irritability Abnormal [rxwiki.com]

  • Confusion

    It’ll help them take action if your low blood sugar levels make you confused. Wear a medical alert bracelet. Make sure it says you use insulin. [webmd.com]

    Also, it is a good idea to let others around you know how to spot your particular signs of low blood sugar levels (and how to react), as you may be too confused (due to low blood sugar levels) to recognize the signs and respond adequately. [diabetes.emedtv.com]

    Symptoms of hypoglycemia include: Anxiety Confusion Extreme hunger Fatigue Irritability Sweating or clammy skin Trembling hands If sugar levels continue to fall during an insulin overdose, serious medical complications and even death. [nursinghomelawcenter.org]

    […] exercise, thus use more glucose than normal miss a meal or don’t eat as much as usual, thus ingesting less glucose Symptoms of too much insulin hyperinsulinism may involve: chills hunger fainting nausea tremors sweating irritability dizziness headache confusion [healthblurbs.com]

    Symptoms of Insulin overdose (hypoglycaemia) Trembling Sweating Dizziness or light-headedness Nervousness or irritability Behaviour and mood changes Headache Weakness Numbness or tingling around the mouth Pale skin Confusion Extreme hunger Extreme symptoms [sundaytimes.lk]

Workup

Inability to maintain euglycemia following glucose administration suggests excessive insulin and requires further workup. Evaluation of serum insulin and C-peptide levels is useful in confirming intentional overdoses in cases that are not clear-cut. [ncbi.nlm.nih.gov]

Unlike the pH during cardiac arrest, interpreting a venous lactate level in relation to an arterial value could be useful in the workup and management of critically ill patients. [forums.studentdoctor.net]

Serum

  • Insulin Increased

    Doctors call this pathology - absolute insulin deficiency. The main sign of it is hyperglycemia - an increase in glucose (sugar) in the blood. [en.intoxication-stop.com]

    Even in a CCB poisoned animal model insulin increases myocardial glucose uptake resulting in improved contractility. [coreem.net]

  • Fasting Hypoglycemia

    Its hallmark presentation is a fasting hypoglycemia because even though the person hasn’t eaten overnight where normally there would be negligible insulin secretion, the insulinoma has run amok and is doing its own thing. [arn.org]

Treatment

First-line treatment was IV glucose treatment in 95% of cases. [ncbi.nlm.nih.gov]

If your symptoms still don’t improve after three treatments, seek medical help immediately. Also, be sure to eat a meal after treating a low blood sugar reaction. [healthline.com]

Prognosis

Assessment of prognosis relies on clinical findings. The observed plasma insulin EC 50 is 46 mIU/l. [ccforum.biomedcentral.com]

However, early presentation has an excellent prognosis with glucose replenishment. Hypoglycaemia can last for days and the erratic release from the subcutaneous tissues creates an unpredictable duration of hypoglycaemia. [lifeinthefastlane.com]

Starter #10 http://www.emedmag.com/html/pre/fea/features/038120044.asp Lactate levels Elevated arterial lactate levels are an early sensitive marker of tissue hypoperfusion, predicting both the severity of hemodynamic compromise and overall patient prognosis [forums.studentdoctor.net]

Etiology

The cases were analyzed in regard to etiology, type of insulin used, concomitant substances being taken by the patient, symptoms and clinical outcome. [ncbi.nlm.nih.gov]

Epidemiology

Epidemiological assessment of 160 cases of insulin overdose recorded in a regional poisons unit. Int J Clin Pharmacol Ther 2004;42(5):277-80. 3. Mégarbane B, Deye N, Bloch V, Sonneville R, Collet C, Launay JM, Baud FJ. [webmedcentral.com]

View Article Google Scholar von Mach MA, Meyer S, Omogbehin B, Kann PH, Weilemann LS: Epidemiological assessment of 160 cases of insulin overdose recorded in a regional poisons unit. Int J Clin Pharmacol Ther 2004, 42: 277-280. [ccforum.biomedcentral.com]

Pathophysiology

Only by understanding the pathophysiology of disease, dysfunction, and death, can one begin to appreciate the complexity of life and how easy it is for us to die and fall off the radar screen for the survival of the fittest. [arn.org]

Prevention

Follow this up with sufficient slower-absorbed carbohydrate, such as bread, to prevent hypoglycemia occurring later. [diabetes.co.uk]

Don’t leave anything to chance and make sure you have eaten enough carbohydrate to prevent hypoglycemia. Very low blood glucose levels can cause us to feel very lethargic and sleepy. [diabetes-ayurveda.com]

[…] of glucose from the polymers in uncooked cornstarch, we hypothesized this might help to prevent nocturnal hypoglycemia. [elsevier.es]

Concerns surrounding the potential provocation of insulin release from beta cells have previously prevented the use of intravenous glucagon as an adjunct to infusion of dextrose in this situation. [ncbi.nlm.nih.gov]

This is to prevent hypoglycemia occurring later on. Test your blood as soon as realise you may have overdosed on insulin. [diabetescommunity.com]

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