Peripheral IV Insulin Infusion Infiltration Presenting as "Insulin Resistance"
Tiffany Y Kim1, Kenneth A Woeber, Heidimarie Windham MacMaster
11Department of Medicine, University of California, San Francisco, CA. 2Departments of Pharmacy and Nursing, University of California, San Francisco, CA.
Critical Care Medicine
|August 12, 2016
Summary
A patient experienced severe hypoglycemia after a peripheral IV insulin infusion infiltrated, creating a large subcutaneous insulin depot. This case highlights the importance of considering infusion site complications in unexplained insulin resistance.
Area of Science:
- Endocrinology
- Pharmacology
- Clinical Medicine
Background:
- Continuous peripheral intravenous (IV) insulin infusion is used for glycemic control, particularly in post-transplant patients on glucocorticoids.
- Unexplained hyperglycemia despite escalating insulin rates can indicate infusion complications.
Observation:
- A 66-year-old lung transplant recipient developed persistent hyperglycemia while on high-dose glucocorticoids and escalating peripheral IV insulin.
- The insulin infusion line was found to have infiltrated, forming a subcutaneous depot of an estimated 450 units of regular insulin.
Findings:
- The subcutaneous insulin depot led to prolonged, severe hypoglycemia requiring management with concentrated dextrose infusions.
- Literature search revealed no similar cases of iatrogenic hyperinsulinemic hypoglycemia due to IV insulin infiltration.
Implications:
- Peripheral IV insulin infiltration must be suspected in cases of apparent insulin resistance.
- Management of iatrogenic hyperinsulinemic hypoglycemia requires anticipating duration, glucose supplementation, fluid balance, and electrolyte monitoring, drawing parallels with insulin overdose literature.
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