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Prolonged hypoglycaemia after insulin lispro overdose.
Miran Brvar1, Martin Mozina, Matjaz Bunc
1Poison Control Center, University Medical Center Ljubljana, Zaloska cesta 7, 1000 Ljubljana, Slovenia.
Summary
Insulin lispro overdose can cause prolonged hypoglycemia lasting over 11 hours. Continuous glucose infusion, matched to the body's needs, may prevent recurrent low blood sugar episodes.
Area of Science:
- Endocrinology
- Toxicology
Background:
- Insulin lispro offers rapid-acting glucose control compared to regular insulin.
- Understanding the pharmacokinetic and pharmacodynamic profile of insulin lispro in overdose is crucial.
Observation:
- A 39-year-old woman self-administered 300 U of insulin lispro, resulting in profound hypoglycemia (0.4 mmol/L).
- The patient experienced recurrent hypoglycemic episodes with neurological symptoms for over 11 hours post-injection, requiring repeated glucose boluses and continuous infusion.
Findings:
- Plasma insulin lispro levels remained significantly elevated for at least 18 hours.
- Hypoglycemia persisted for over 11 hours, indicating a prolonged effect beyond typical expectations.
Implications:
- Insulin lispro overdose necessitates prolonged monitoring and aggressive glucose management.
- Optimizing glucose infusion rates to match maximal glucose disposal may prevent recurrent hypoglycemia in overdose cases.