Skip to main content Accessibility help
×
Home

Octreotide for the treatment of intentional insulin aspart overdose in a non-diabetic patient

  • Catherine M. Dewaal (a1), Eric McGillis (a2) (a3), Matt Mink (a4) and Scott Lucyk (a2) (a4) (a3)

Abstract

Intentional insulin overdose may lead to severe and refractory hypoglycemia. Exogenous dextrose administration is the mainstay of therapy for these patients and is effective in most cases. However, in patients with a functional pancreas, exogenous dextrose administration may precipitate endogenous insulin release leading to rebound hypoglycemia. We describe a case report of a 41-year-old woman who injected 300 units of insulin aspart with suicidal intent. Her initial blood glucose was 2.3 mmol/L (41 mg/dL). Over the next 12 hours, she experienced recurrent hypoglycemic episodes despite 10% dextrose infusions and 14 ampoules of 50% dextrose. Our patient experienced complications, including peripheral edema, related to the large volumes of intravenous dextrose required to attempt to maintain euglycemia. Octreotide, a somatostatin analogue, may help prevent dextrose-induced hypoglycemia and improve the management in select insulin overdose patients; large infusion volumes resulted in significant peripheral edema. Treatment with octreotide was initiated 12.5 hours post-injection and was followed by a stabilization of blood glucose concentration in this non-diabetic patient.

Une surdose intentionnelle d’insuline peut entraîner une hypoglycémie très grave, réfractaire au traitement. Celui-ci consiste principalement en l’administration de dextrose exogène, et il se montre efficace dans la plupart des cas. Toutefois, chez les personnes chez qui le pancréas est en état de fonctionnement, l’administration de dextrose exogène peut provoquer la libération endogène d’insuline, ce qui peut provoquer à son tour une hypoglycémie rebond. Sera exposé ici le cas d’une femme de 41 ans, aux idées suicidaires, qui s’est injectée 300 unités d’insuline aspart. À l’arrivée de la patiente, la glycémie était de 2,3 mmol/l (41 mg/dl). Au cours des 12 heures suivantes, il s’est produit d’autres épisodes d’hypoglycémie, malgré les perfusions de dextrose à 10 % et l’injection de 14 ampoules de dextrose à 50 %. S’en sont suivies des complications, notamment un œdème périphérique, lié à l’administration de quantités importantes de dextrose par voie intraveineuse dans le but de maintenir la glycémie normale. Toutefois, l’octréotide, un analogue de la somatostatine, peut aider à prévenir l’hypoglycémie secondaire à l’administration de dextrose et à améliorer la prise en charge des surdoses d’insuline chez certains patients; la perfusion de grandes quantités de liquides s’est soldée par un œdème périphérique important. Le traitement par l’octréotide a été entrepris 12,5 heures après l’injection d’insuline, et il a permis de stabiliser la glycémie chez cette patiente non diabétique.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Octreotide for the treatment of intentional insulin aspart overdose in a non-diabetic patient
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Octreotide for the treatment of intentional insulin aspart overdose in a non-diabetic patient
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Octreotide for the treatment of intentional insulin aspart overdose in a non-diabetic patient
      Available formats
      ×

Copyright

Corresponding author

Correspondence to: Dr. Catherine M. Dewaal, Pharmacy Services, South Health Campus, Alberta Health Services, 4448 Front Street SE, Calgary, AB T3M 1M4; Email: catherine.dewaal@albertahealthservices.ca

References

Hide All
1. Mowry, JB, Spyker, DA, Brooks, DE, et al. 2015. Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 33rd annual report. Clin Toxicol 2016;54(10):924-1109, 10.1080/15563650.2016.1245421.
2. Lu, M, Inboriboon, PC. Lantus insulin overdose: a case report. J Emerg Med 2011;41(4):374-377.
3. Klein-Schwartz, W, Stassinos, GL, Isbister, GK. Treatment of sulfonylurea and insulin overdose. Br J Clin Pharmacol 2015;81(3):496-504.
4. Glatstein, M, Scolnik, D, Bentur, Y. Octreotide for the treatment of sulfonylurea poisoning. Clin Toxicol 2012;50:795-804.
5. Fuller, ET, Miller, MA, Kaylor, DW, et al. Lantus overdose: case presentation and management options. J Emerg Med 2009;36(1):26-29.
6. Groth, CM, Banzon, ER. Octreotide for the treatment of hypoglycemia after insulin glargine overdose. J Emerg Med 2013;45(2):194-198.
7. NovoRapid. Product Monograph. Mississauga, ON: Novo Nordisk Canada Inc.; 2016.
8. Binder, C, Lauritzen, T, Faber, O, et al. Insulin pharmacokinetics. Diabetes Care 1984;7(2):188-199.
9. Efrimescu, C, Yagoub, E, Doyle, R. Intentional insulin overdose associated with minimal hypoglycemic symptoms in a non-diabetic patient. Maedica (Buchar) 2013;8(4):365-369.
10. Dougherty, PP, Klein-Schwartz, W. Octreotide’s role in the management of sulfonylurea-induced hypoglycemia. J Med Toxicol 2010;6:199-206, 10.1007/s13181-010-0064-z.
11. Arem, R, Zoghbi, W. Insulin overdose in eight patients: insulin pharmacokinetics and review of the literature. Medicine 1985;64(5):323-332.
12. Bosse, GM. Antidiabetics and hypoglycemics. In Goldfrank’s toxicologic emergencies. 10th ed. New York, NY: McGraw-Hill Education; 2015: 720-731.

Keywords

Octreotide for the treatment of intentional insulin aspart overdose in a non-diabetic patient

  • Catherine M. Dewaal (a1), Eric McGillis (a2) (a3), Matt Mink (a4) and Scott Lucyk (a2) (a4) (a3)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed