Related Experiment Video
Updated: May 19, 2026
12:08
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Massive levemir (long-acting) insulin overdose: case report
1St Mary's Hospital, Imperial College Healthcare Trust, London W2 1NY, UK.
Case Reports in Medicine
|August 28, 2012
Summary
Massive insulin overdose, especially with alcohol, can cause prolonged hypoglycemia and neurological damage. Prompt, intensive glucose management is crucial for patient survival and recovery.
Area of Science:
- Endocrinology
- Toxicology
- Emergency Medicine
Background:
- Insulin overdoses are a significant clinical concern, frequently involving co-ingestion of alcohol or other substances that potentiate hypoglycemia.
- Severe hypoglycemia can lead to serious complications including neurological damage, liver enzyme derangement, and electrolyte abnormalities.
Purpose of the Study:
- To report a case of massive long-acting insulin overdose complicated by alcohol consumption.
- To highlight the challenges in managing persistent hypoglycemia and associated complications.
Main Methods:
- A 52-year-old male with diabetes mellitus presented after a deliberate overdose of 2100 units of insulin and alcohol.
- Initial management included dextrose boluses and continuous intravenous dextrose infusions.
- Treatment involved symptomatic management of recurrent hypoglycemic episodes with oral glucose, glucagon, and further dextrose administration, alongside electrolyte and pH monitoring.
Main Results:
- The patient experienced recurrent symptomatic hypoglycemia for 12 hours despite aggressive dextrose therapy.
- Continuous intravenous dextrose infusions were necessary to maintain glycemic control.
- The case underscores the potential for prolonged and severe hypoglycemia following massive insulin overdose.
Conclusions:
- Massive insulin overdose, particularly when combined with alcohol, poses a substantial risk of persistent hypoglycemia and severe adverse outcomes.
- Patients presenting with a decreased Glasgow Coma Scale (GCS) after overdose have a poorer prognosis.
- Intensive and prolonged glucose monitoring and management are essential in these critical cases.
Related Concept Videos
01:16Insulin: Dosing Regimen and Adverse Effects
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
01:15Hypoglycemia and Glucagon
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
01:27Insulin Formulations: Types and Delivery
Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
Short-acting insulins are divided into rapid-acting...
Short-acting insulins are divided into rapid-acting...
01:26Hypoglycemia
Hypoglycemia is a blood glucose level below 70 mg/dL. It commonly occurs in individuals using insulin or insulin-secreting drugs, but may also arise in non-diabetic conditions. People with type 1 diabetes are at the highest risk because they depend on exogenous insulin. People with type 2 diabetes are also at risk, especially when treated with insulin or medications such as sulfonylureas, which increase insulin release regardless of blood glucose levels. It develops when insulin levels exceed...
01:26Pharmaceutical Poisoning: Potential Scenarios
Pharmaceutical poisoning can occur through various channels, impacting an estimated 2 million hospitalized patients in the U.S. annually with serious adverse drug responses. These scenarios encompass both therapeutic uses, such as drug toxicity, where even standard dosages can lead to severe central nervous system depression, and non-therapeutic exposures, including accidental ingestion by children, and environmental and occupational exposures.Unintentional poisonings often involve exploratory...
01:29Hyperglycemia
Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...