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Related Experiment Videos

Intentional massive insulin overdose: recognition and management

R J Roberge1, T G Martin, T R Delbridge

  • 1Toxicology Treatment Program, University of Pittsburgh Medical Center, Pennsylvania.

Annals of Emergency Medicine
|February 1, 1993
PubMed
Summary

Intentional massive insulin overdose requires prolonged glucose support. Emergency physicians should suspect suicidal intent in nonresponsive hypoglycemia, guiding further workup and tailored glucose infusion rates.

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Area of Science:

  • Endocrinology
  • Toxicology
  • Emergency Medicine

Background:

  • Intentional insulin overdose is an underrecognized cause of severe hypoglycemia.
  • Hypoglycemia evaluations are common in emergency departments (EDs).

Observation:

  • A case of massive intentional insulin overdose requiring prolonged glycemic support is presented.
  • Patients with hypoglycemia minimally responsive to glucose or non-diabetics with access to insulin warrant suspicion for intentional overdose.
  • Monitoring glucose levels post-administration and assessing serum insulin/C-peptide aid diagnosis.

Findings:

  • Inability to maintain euglycemia after glucose administration indicates excessive insulin.
  • Individualized glucose infusion rates are crucial due to variable insulin absorption and effects.

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  • Prolonged glycemic support is often necessary.

    • Implications:

    • Emergency physicians must maintain a high index of suspicion for intentional insulin overdose.
    • Routine glucose monitoring and specific lab tests can confirm diagnosis.
    • Tailored management is essential for successful patient outcomes in these critical cases.