Related Experiment Video
Updated: May 15, 2026
12:08
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Insulin glargine overdose
Fatma Sarı Doğan1, Ozge Ecmel Onur, Arzu Denizbaşı Altınok
1Department of Emergency Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey.
Journal of Pharmacology & Pharmacotherapeutics
|January 18, 2013
Summary
This case study highlights that prolonged glucose infusion is crucial for managing severe hypoglycemia from insulin glargine overdose. Extended monitoring is necessary due to the unpredictable duration of action for this long-acting insulin.
Area of Science:
- Endocrinology
- Pharmacology
Background:
- Insulin glargine, a long-acting insulin analogue, improves glycemic control in type 1 and type 2 diabetes mellitus.
- Its duration of action can vary significantly between individuals, with no defined half-life or peak effect.
- Hypoglycemia is a common adverse effect of insulin therapy, including insulin glargine.
Observation:
- A case of a 76-year-old male with insulin-dependent diabetes experiencing refractory hypoglycemia is presented.
- This hypoglycemia was secondary to an intentional overdose of insulin glargine.
- The patient required prolonged intravenous glucose infusion due to the extended action of the insulin analogue.
Findings:
- Intentional massive overdose of insulin glargine can lead to prolonged and severe hypoglycemia.
- The pharmacokinetic properties of insulin glargine may not accurately predict the duration of its hypoglycemic effect in overdose scenarios.
- Standard treatment protocols may need adjustment for extended periods in cases of significant overdose.
Implications:
- Clinicians must be aware of the potential for prolonged hypoglycemia with insulin glargine overdose.
- Extended intravenous glucose infusion is necessary for managing such cases, potentially longer than anticipated.
- This case underscores the importance of vigilant monitoring and tailored treatment strategies for patients with massive insulin analogue overdoses.
Related Concept Videos
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...
01:29Hyperglycemia
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...
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...
01:06Oral Hypoglycemic Agents: Glinides
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively manages...
01:24Glucagon-like Receptor Agonists
Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by the...
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by the...
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...