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Toxicology – Insulin Overdose
Source
Insulin is used in various formulations for the management of diabetes mellitus. These include rapid-acting types (e.g., aspart, lispro, glulisine), short-acting (regular insulin), intermediate-acting (NPH), and long-acting forms (e.g., glargine, detemir). Each differs in onset and duration of action.
Typical Presentation
Patients may present after intentional or accidental overdose, often with altered consciousness. Severe cases may involve seizures or coma due to profound hypoglycemia.
Clinical Features
The primary manifestation is hypoglycemia, which can present with sweating, tachycardia, tremors, confusion, seizures, or coma. Some individuals may tolerate low glucose levels with minimal symptoms, while others deteriorate rapidly. Electrolyte abnormalities such as low potassium and magnesium may lead to cardiac arrhythmias. Additional findings may include hypothermia and, in severe cases, focal neurological deficits that can mimic stroke. Pulmonary edema and low phosphate levels have also been reported in significant overdoses.
Mechanism of Action
Insulin promotes the uptake of glucose into cells, particularly in the liver, muscle, and adipose tissue. Excess insulin leads to a rapid drop in blood glucose levels. The duration and severity of hypoglycemia depend on the type and amount of insulin administered.
Management
Immediate treatment involves administration of intravenous dextrose (e.g., D50) to rapidly correct hypoglycemia and restore neurological function. Continuous glucose monitoring with frequent checks is essential. Ongoing intravenous dextrose infusion may be required, along with correction of electrolyte imbalances.
Key Points
Source
Insulin is used in various formulations for the management of diabetes mellitus. These include rapid-acting types (e.g., aspart, lispro, glulisine), short-acting (regular insulin), intermediate-acting (NPH), and long-acting forms (e.g., glargine, detemir). Each differs in onset and duration of action.
Typical Presentation
Patients may present after intentional or accidental overdose, often with altered consciousness. Severe cases may involve seizures or coma due to profound hypoglycemia.
Clinical Features
The primary manifestation is hypoglycemia, which can present with sweating, tachycardia, tremors, confusion, seizures, or coma. Some individuals may tolerate low glucose levels with minimal symptoms, while others deteriorate rapidly. Electrolyte abnormalities such as low potassium and magnesium may lead to cardiac arrhythmias. Additional findings may include hypothermia and, in severe cases, focal neurological deficits that can mimic stroke. Pulmonary edema and low phosphate levels have also been reported in significant overdoses.
Mechanism of Action
Insulin promotes the uptake of glucose into cells, particularly in the liver, muscle, and adipose tissue. Excess insulin leads to a rapid drop in blood glucose levels. The duration and severity of hypoglycemia depend on the type and amount of insulin administered.
Management
Immediate treatment involves administration of intravenous dextrose (e.g., D50) to rapidly correct hypoglycemia and restore neurological function. Continuous glucose monitoring with frequent checks is essential. Ongoing intravenous dextrose infusion may be required, along with correction of electrolyte imbalances.
Key Points
- Large or subcutaneous injections may create a “depot effect,” leading to prolonged hypoglycemia.
- Delayed absorption can result in recurrent or persistent symptoms.
- Early treatment is critical; prolonged hypoglycemia worsens prognosis.
- Elevated C-peptide levels suggest endogenous insulin production rather than exogenous overdose.
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