Lantus overdose: case presentation and management options

Insulin glargine (Lantus, Aventis Pharmaceuticals, Bridgewater, NJ) is a long-acting once-daily dosed form of insulin intended to maintain a constant baseline insulin level. As a relatively new medication, there is limited experience in overdoses of Lantus. We present a case of a 37-year-old male insulin-dependent diabetic presenting with refractory hypoglycemia secondary to an intentional overdose of Lantus insulin to illustrate the varied management concerns in overdoses of long-acting insulins. The patient was managed with oral intake, intravenous dextrose bolus, peripheral 10% dextrose solution, 25% dextrose sliding scale via central line, and psychiatry evaluation for suicide attempt. Other potential treatments discussed for possible use with long-acting insulin overdoses include incision and drainage of the injection site, glucagon, and octreotide.