Massive Levemir (long-acting) Insulin Overdose: Case Report
Case Reports in Medicine Volume 2012 (2012), Article ID 904841, 3 pages 1St Mary's Hospital, Imperial College Healthcare Trust, London W2 1NY, UK 2Cardiology Department, Tahir Heart Institute, Rabwah, Jhang 35460, Pakistan Academic Editor: Linda Gonder-Frederick Copyright © 2012 Mamatha Oduru and Mahmood Ahmad. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 52-year-old insulin-dependant diabetic man presented to the Emergency Department 2 hours after a deliberate massive overdose of 2100 units of long-acting Levemir insulin and a large quantity of whisky. On initial assessment, his GCS was 3/15 and his capillary blood sugar was 2.6 mmol/L. The patient was given a 50 ml bolus of 50% dextrose, followed by intravenous infusions of both 5% and 10% dextrose. Despite the continuous infusions, he experienced 4 symptomatic hypoglycaemic episodes in the first 12 hours after admission. These were managed with oral glucose, IM glucagon, and further dextrose boluses. Blood electrolytes and pH were monitored throughout. Insulin overdoses are relatively common and often occur with an excess of other drugs or alcohol which can enhance its action. Overdoses can result in persistent hypoglycaemia, liver enzyme derangement, electrolyte abnormalities, and neurological damage. Overall mortality is 2.7% with prognosis poorest in patients who are admitted with decreased Glasgow Coma scale (GCS) 12 hours after overdose. 1. Case Presentation A 52-year-old man was brought to the Emergency Department after a deliberate huge overdose of long-acting Levemir insulin following an argument with his partner. He reported injecting Continue reading >>
Tweet Save If you take too much insulin, symptoms of an overdose may include blurry vision, shakiness, and extreme hunger. These are the early symptoms of low blood sugar levels. More severe (and potentially life-threatening) problems may include seizures, difficulty speaking, and loss of consciousness. Treatment for an overdose of insulin involves supportive care, which consists of treating the symptoms that occur as a result of the overdose. Can You Overdose on Insulin? An insulin overdose can be extremely dangerous. Insulin can be a difficult medication to properly dose, and it is actually fairly easy to accidentally overdose on this medication. It is very important to recognize the symptoms of an overdose and to know exactly how to respond. If you or someone else may have overdosed on insulin, seek immediate medical attention. General Information on an Insulin Overdose An overdose with a short- or rapid-acting insulin is typically more dangerous than an overdose with an intermediate- or long-acting insulin (although an overdose with any type of insulin can be lethal). An overdose of insulin can be caused by several factors, such as misjudging how much insulin is needed. Also, not eating after taking a dose of a rapid- or short-acting insulin may result in an overdose. Eating less or exercising more than usual could also lead to an insulin overdose. Symptoms of an Overdose An insulin overdose can cause low blood sugar levels (hypoglycemia), which can be quite dangerous. Some of the early symptoms of low blood sugar include: Sweating Extreme hunger Dizziness Cold sweats Shakiness Blurry vision. More severe symptoms include: Loss of consciousness Changes in behavior, such as irritability Loss of coordination Difficulty speaking Confusion Coma Loss of life. You may find Continue reading >>
Injecting an erroneously high amount of insulin can become serious, depending on how much higher your dose was than it should have been. Hypoglycemia can be caused from taking too much insulin, and you should consume fast-acting carbohydrates as soon as possible before urgently seeking advice from professional healthcare providers. Initial symptoms of an insulin overdose The initial symptoms of low blood sugar caused by an overdose of insulin can become more severe if not acted upon immediately. These include: Confusion Dizziness Drowsiness Extreme hunger Headache Irritability Mood changes Nausea Nervousness Rapid heartbeat Sleep disturbances Slurred speech Sweating Trembling Trouble concentrating Unsteady movements Severe symptoms of an insulin overdose If your blood sugar levels continue to fall due to a larger dose of insulin, serious complications and more severe symptoms can arise, such as: Coma Disorientation Pale skin Seizures What can cause an insulin overdose? There are several common reasons for there being too much insulin in your system, with certain mistakes liable to result in insulin overdose including: Injecting the wrong insulin – If you inject quick acting insulin instead of your long lasting insulin Injecting, but not eating – missing out or delaying a scheduled meal or snack after an injection Miscalculating carbohydrate content of a meal Problems viewing numbers or gradation on insulin syringe or pen Injecting twice for the same meal or snack How to treat an insulin overdose If you have overdosed on insulin you will need to stop what you were doing and dedicate your immediate time to restoring your blood sugar levels up. Fast-acting carbohydrate such as a very sugary drink or glucose tablets should be consumed, with carbohydrate absorbed more sl Continue reading >>
Intentional Overdose With Insulin: Prognostic Factors And Toxicokinetic/toxicodynamic Profiles
Abstract Prognostic factors in intentional insulin self-poisoning and the significance of plasma insulin levels are unclear. We therefore conducted this study to investigate prognostic factors in insulin poisoning, in relation to the value of plasma insulin concentration. We conducted a prospective study, and used logistic regression to explore prognostic factors and modelling to investigate toxicokinetic/toxicodynamic relationships. Twenty-five patients (14 female and 11 male; median [25th to 75th percentiles] age 46 [36 to 58] years) were included. On presentation, the Glasgow Coma Scale score was 9 (4 to 14) and the capillary glucose concentration was 1.4 (1.1 to 2.3) mmol/l. The plasma insulin concentration was 197 (161 to 1,566) mIU/l and the cumulative amount of glucose infused was 301 (184 to 1,056) g. Four patients developed sequelae resulting in two deaths. Delay to therapy in excess of 6 hours (odds ratio 60.0, 95% confidence interval 2.9 to 1,236.7) and ventilation for longer than 48 hours (odds ratio 28.5, 95% confidence interval 1.9 to 420.6) were identified as independent prognostic factors. Toxicokinetic/toxicodynamic relationships between glucose infusion rates and insulin concentrations fit the maximum measured glucose infusion rate (Emax) model (Emax 29.5 [17.5 to 41.1] g/hour, concentration associated with the half-maximum glucose infusion rate [EC50] 46 [35 to 161] mIU/l, and R2 range 0.70 to 0.98; n = 6). Intentional insulin overdose is rare. Assessment of prognosis relies on clinical findings. The observed plasma insulin EC50 is 46 mIU/l. Introduction Contrasting with the common occurrence of insulin-induced hypoglycaemia in type 1 diabetes patients, deliberate overdose with insulin are rarely reported . In the 2005 Annual Report of the American Continue reading >>
How To Deal With An Insulin Overdose And Other Insulin Complications
Administering too high a dose of insulin for diabetes can cause cold sweats, trembling hands, intense anxiety and a general sense of confusion because of low blood sugar or hypoglycaemia. Learn more about avoiding hypoglycaemia from an insulin overdose. When insulin works too well Insulin stimulates the cells of the body to absorb sugar (glucose) out of the blood. It also inhibits the production of glucose by the liver. In type 1 diabetes no insulin is present. In type 2 diabetes, the body is resistant to the insulin that's there. All people with type 1 diabetes need insulin injections. Many people with type 2 diabetes - those whose blood sugar can't be controlled with oral medicines, diet and exercise - need insulin injections. There are several ways you can get too much insulin in your system: You inject too much insulin because you have difficulty reading the syringes or vials or are unfamiliar with a new product. You inject the right amount of insulin but the wrong type. For instance, you normally take 30 units of long-acting and 10 units of short-acting insulin. Injecting 30 units of short-acting insulin is an easy mistake to make. You inject insulin, but then don't eat. Insulin injections should be timed with meals. Blood sugar rises after meals, but without eating, insulin lowers blood sugar to a potentially dangerous level. Symptoms of an insulin overdose It doesn't matter how it happens. An insulin overdose always has the same effect - low blood sugar levels, or hypoglycaemia. Symptoms of hypoglycaemia include: Anxiety Confusion Extreme hunger Fatigue Irritability Sweating or clammy skin Trembling hands. If sugar levels continue to fall during an insulin overdose, serious complications - seizures and unconsciousness - can occur. Low blood sugar, or hypoglycaemi Continue reading >>
What Happens If I Miss A Dose (lantus, Lantus Opticlik Cartridge, Lantus Solostar Pen)?
A A A insulin glargine (cont.) Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose. You should not use more than one dose in a 24-hour period unless your doctor tells you to. Keep insulin glargine on hand at all times. Get your prescription refilled before you run out of medicine completely. What happens if I overdose (Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen)? Seek emergency medical attention if you think you have used too much of this medicine. An insulin overdose can cause life-threatening hypoglycemia. What should I avoid while using insulin glargine (Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen)? Do not change the brand of insulin glargine or syringe you are using without first talking to your doctor or pharmacist. Avoid drinking alcohol. It lowers blood sugar and may interfere with your diabetes treatment. What other drugs will affect insulin glargine (Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen)? Using certain medicines can make it harder for you to tell when you have low blood sugar. Tell your doctor if you use any of the following: albuterol (Proventil, Ventolin); clonidine (Catapres); reserpine; or a beta-blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others. There are many other medicines that can increase or decrease the effects of insulin glargine on lowering your blood sugar. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your Continue reading >>
Is Your Cat In A Diabetic Coma?
Cats with diabetes need continuous care. Unlike diabetic humans who can check their own blood sugar levels, cats rely on their owners to properly monitor what's happening in their pancreas. That twice-daily dosage of insulin given under his skin may require adjustment, depending on a variety of factors. You can keep your diabetic cat on track by knowing what's going on, and what to expect, particularly in the case of a diabetic coma. How common is feline diabetes? Some estimates suggest that one out of 1,200 cats will develop diabetes in their lifetimes, although this disease most often afflicts older or overweight cats. A diabetic cat suffers a deficiency of insulin, the pancreatic hormone that converts glucose, the fuel we get from food, into energy. A diabetic cat's body either cannot produce enough insulin, or cannot process it correctly. Without insulin controlling the flow of glucose from the cat's bloodstream into its body cells, the cat's body uses its own fat and protein to survive. High blood glucose levels force glucose to be processed into the urine, leading to excessive urination. Most cats contract an insulin-dependent type of diabetes, requiring insulin injections to control their illness. Felines suffering non-insulin-dependent diabetes will eventually need insulin injections as the disease progresses. Signs of diabetes An early warning of feline diabetes is frequent urination. A diabetic cat may also urinate, or attempt to do so, outside of his litter box. You may see him straining to urinate, a symptom of a urinary tract infection common to diabetic felines. He'll consume larger amounts of water, and return to his water bowl more often, because his glucose-heavy urine passes more water from his system. His appetite may change, too, as he either loses i Continue reading >>
Side Effects Of Taking Insulin When You Don't Need It
Insulin-dependent diabetics take insulin injections because their pancreas no longer produces insulin. Insulin helps cells absorb glucose, the body’s main energy source, from the blood. All Type 1 diabetics, formerly called juvenile diabetics, and some Type 2 diabetics, formerly called adult-onset diabetics, need insulin because their bodies no longer produce enough of the hormone. Without insulin to remove glucose from the blood, blood glucose levels rise, a condition called hyperglycemia. Taking too much insulin or taking insulin when your body already makes enough removes too much glucose from the blood, a condition called hypoglycemia, or low blood sugar. Video of the Day All cells require glucose to function. When you eat, carbohydrates in the food break down in the intestines into glucose. The blood absorbs the glucose. When this happens, your blood glucose levels rise. In response to the increase in blood sugar, the pancreas releases insulin. Insulin facilitates a cell’s ability to remove glucose from the blood and utilize it for energy. If your body has already released enough insulin and you take more, too much glucose is removed from your blood and you become hypoglycemic. Taking an overdose of short-acting or intermediate-acting insulin is more dangerous than taking too much long-acting insulin, eMedTV explains. Taking insulin when you don’t need it causes symptoms such as sweating, shaking, headache, irritability, nervousness, anxiety, weakness, dizziness, hunger, tremors, nausea, and difficulty concentrating or thinking. For diabetics, the treatment for hypoglycemia is to eat something containing quickly absorbed glucose, such as candy or special glucose tablets. If you have a hypoglycemic reaction and take glucose, follow up with a snack containing b Continue reading >>
Insulin Overdose: Dosage, Symptoms, And Treatment
Insulin is an important hormone used in medical treatments for people with type 1 and type 2 diabetes. It helps the body's cells to properly absorb sugar. Insulin is a lifesaving medication when taken correctly, but an insulin overdose can have some serious side effects. This article explores signs of insulin overdose to look out for, as well as steps to take to avoid insulin overdoses. Contents of this article: Safe vs. unsafe insulin doses There are a few things to consider to ensure a correct insulin dose. Insulin doses can vary greatly from person to person. The normal dose for one person may be considered an overdose for another. Basal insulin The insulin needed to keep the blood sugar steady throughout the day is called basal insulin. The amount of insulin needed changes from person to person based on what time of day they take it, and whether their body is resistant to insulin or not. It is best to consult a doctor to figure out the appropriate basal insulin dosage. Mealtime insulin Mealtime insulin is insulin that is taken after a meal. Glucose (sugar) is released into the bloodstream as the body breaks down food, which raises the blood sugar levels. In people with diabetes, this extra sugar must be met with extra insulin so the body can use it properly. There are a few different factors to be considered in terms of the mealtime insulin levels. People with diabetes have to consider: their pre-meal blood sugar how many carbs are in the food they are eating if they plan to do anything active after the meal Then they must factor in their own level of insulin sensitivity and the blood sugar target they want to hit after the insulin is taken. The process can be complicated and, as such, there is room for error. Other variables There are also a few different types of Continue reading >>
The Side Effects Of Insulin In Dogs
Diabetes mellitus develops when your dog's body loses its ability to produce insulin on its own. Insulin therapy, administered through injections underneath your dog's skin, is widely used to help your diabetic dog regulate its blood glucose. As essential as insulin is to a diabetic dog, it carries with it a number of side effects. These side effects are potentially life-threatening and should be reported to a veterinarian immediately. Food is broken down by your dog's body into separate organic compounds; glucose is one of these. Glucose, an energy source for movement, growth and other functions, needs the hormone insulin to transfer from the bloodstream into individual cells. The pancreas produces insulin and, in a healthy dog, produces and releases enough insulin to match the amount of glucose in the bloodstream. However, when a dog develops diabetes mellitus, his owner must administer insulin to him through subcutaneous (underneath the skin) injections to maintain the body's proper blood glucose/insulin balance. Hypoglycemia (low blood sugar) is the most common side effect associated with insulin. It is an extremely serious medical condition that comes on suddenly, requiring immediate attention. Before taking your dog to your veterinarian, it is critical that you immediately feed her approximately 1 tbsp. of a fast-acting glucose, such as corn syrup or honey, first by rubbing a small amount on your dog's gums and then feeding her by mouth when she regains her swallowing functions. An insulin overdose, missed morning meal or overexertion can trigger low blood sugar. Symptoms include hunger, lethargy and sleepiness in the early stages, followed by staggering gait, then twitching, convulsions, coma and death. Certain medications, such as corticosteroids, propranolol, t Continue reading >>
Diabetes Prescription Insulin Medications (cont.)
font size A A A Previous 1 2 3 4 5 Next What are the side effects of the diabetes drug insulin? The main side effects of insulin have to do with taking too little or too much of the drug. The former can result in high blood sugar, or hyperglycemia. A person with diabetes who has hyperglycemia frequently or for long periods of time may suffer damage to the blood vessels, nerves, and organs. In a worst-case scenario, hyperglycemia can lead to diabetic ketoacidosis, a potentially life-threatening condition. Loss of appetite, thirst, flushing, drowsiness, and a fruity odor on the breath are the first signs of diabetic ketoacidosis. Low blood sugar, or hypoglycemia can result from taking too much insulin, although missing meals and exercising excessively can also bring it on. This, too, can be a life-threatening. Initial signs of hypoglycemia include dizziness, sweating, tremor, confusion, and hunger. It's important to intervene before symptoms progress. High doses of insulin can lower levels of potassium. If potassium gets too low, it can cause muscle aches or weakness, abnormal heart rhythms and even death. Other side effects of insulin include break down of fat at the injection site, the injection site might be depressed or raised, and allergic reactions, which can be local or involve the entire body. The latter may be life-threatening. lower your blood sugar Amputations. INVOKANA® may increase your risk of lower-limb amputations. Amputations mainly involve removal of the toe or part of the foot; however, amputations involving the leg, below and above the knee, have also occurred. Some people had more than one amputation, some on both sides of the body. You may be at a higher risk of lower-limb amputation if you: have a history of amputation, have heart disease or are at Continue reading >>
An Accidental Over Dial Leads To An Overdose
With millions of Americans suffering from diabetes, there has been tremendous growth in the use of insulin. For convenience, many insulin dependent diabetics carry their insulin in a prefilled syringe available from drug manufacturers. The device is called an insulin pen because it looks similar to a writing pen and can be carried in your pocket. An insulin pen is designed to give multiple injections of insulin after changing the single use attachable needle. Occasionally a patient may use the pen incorrectly resulting in serious side effects. Patients who are new to using an insulin pen are at most risk for making a mistake.Recently, we received an interesting report from a Certified Diabetes Educator (CDE)/RN about a first time user of an insulin pen who suffered an insulin overdose by misreading the amount dialed on an insulin pen device. The patient, who was admitted to the hospital with a dangerously low blood sugar, had been instructed by her doctor to give herself 6 units of NovoLog insulin using the pen device. As with other insulin pens, this device works by turning a dose selector dial to set the pen to deliver the prescribed amount (Figure 1a). The dose then appears in a little built-in window on the pen (Figure 1b). Once you set the dose, you inject the pen’s needle (1c) into your skin and push a button to release the dose of insulin (Figure 1d). After talking to the patient, it was determined how the overdose occurred. The patient misunderstood where to read her insulin dose! Instead of reading her dose within the little built in window, she read the dose to the right of the window (Figure 2). When the woman began to turn the dose selector dial, she looked to the right of the window, not within the window. When she saw the number six she thought that was Continue reading >>
Woman Kills Herself By Insulin Overdose
“I LOVE you” were the last words a diabetic woman wrote in a suicide note to her step-daughter before killing herself with an insulin overdose. Andrea Smith had already tried to kill herself once with an insulin overdose in the months leading up to her death, aged 45, on August 8 last year, Aberdare Coroner’s Court was told. She had attempted to take her own life in May 2008 with insulin and tablets, which had led to her month-long admission to Royal Glamorgan Hospital’s psychiatric ward. In a statement read to the court, step-daughter Susan Davies said that on that occasion she had found her step-mother sitting grey-faced on the bed with eight empty insulin pens by her side. “She said that I had caught her in time but that next time I would not be so lucky,” said Susan. She had called into her step-mother’s home at Cae Glas, Penrhiwfer, Tonypandy, after concerned neighbours contacted her to say the cat was crying outside and had been there for some time, which was unusual. Andrea, a cashier at a local petrol station, was discharged in June and was under the care of a crisis team who made several visits a week. The court heard she had a history of depression for which she was receiving medication, and stomach problems and was receiving treatment for a hernia. She had become depressed following her mother’s death in 2005 and was also upset because her dog had died and she had taken it badly. Susan said she was in regular touch with Andrea. She said that her step-mother and father had not been getting on well and on the Tuesday before the death he had taken his wife to work for the night shift and by the time she returned, he was gone. Susan took her to work the following day. “She was laughing and joking and she said that she had to be strong,” said S Continue reading >>
What Is Toujeo (insulin Glargine)?
Toujeo is a brand name for the medicine insulin glargine, available in a prefilled injectable pen (SoloStar). It's used to treat people with type 1 diabetes (the body doesn't produce the hormone insulin) and type 2 diabetes (the body doesn't make or use insulin normally). Toujeo is a long-acting form of insulin that works by helping your body use sugar properly. For people with type 1 diabetes, Toujeo must be used with another type of insulin known as a short-acting insulin. People with type 2 diabetes may use other types of insulin or oral drugs along with Toujeo. Taking this prescription medicine along with adopting a healthy lifestyle can decrease your risk of developing serious or life-threatening complications, which may include heart disease, stroke, nerve damage from neuropathy, kidney problems, or eye issues. The Food and Drug Administration (FDA) approved Toujeo in 2015. It's marketed by Sanofi. Toujeo Warnings Toujeo shouldn't be used to treat diabetic ketoacidosis, a dangerous condition that can occur if high blood sugar is untreated. Before using Toujeo, tell your doctor if you have or have ever had: Diabetic neuropathy Heart, liver, or kidney disease Hypokalemia (low potassium levels in the blood) A severe allergic reaction (anaphylaxis) to any medicines, especially insulin products Toujeo shouldn't be used in children, and it should be used with caution in elderly people. Be sure to let your physician know that you're taking Toujeo before having any type of surgery, including a dental procedure. Your healthcare provider may recommend that you follow a specific diet and exercise plan while using Toujeo. Follow your doctor's instructions carefully. Illnesses, injuries, or unusual stress can affect your blood sugar levels. Talk to your physician if you experi Continue reading >>
Diabetes Warning: What Is Insulin Overdose That May Have Killed Actor Iain Rogerson?
Former Coronation Street actor Iain Rogerson, who played Henry Flagg in the ITV show, died from a suspected insulin overdose on October 13, according to reports. Insulin is used to normalise blood sugar levels in diabetes patients. Too much insulin causes an overdose, and leads to hypoglycaemia. The condition’s symptoms include double vision, confusion and shakiness. In most extreme cases, it can causes patients to lose consciousness, and even die. Having too little glucose in the bloodstream means the body can’t operate properly. Every patient reacts differently to low levels of glucose. Common symptoms of mild hypoglycaemia include shakiness, a rapid heartbeat, irritability and tingling in the lips or around the mouth. Patients with low blood sugar levels should eat about 15g of a high-sugar food, including honey, raisins or chocolate. The amount of insulin diabetics need varies from person to person. It depends on the type of insulin taken and the body’s sensitivity o the hormone. The strength of insulin also varies. The most common strength is the equivalent of 100 units of insulin per ml of fluid. But, some people require a higher dosage, so it’s available up to 500 units of insulin per ml of fluid. Overdosing on insulin isn’t difficult, according to Healthline.com. You can overdose from the hormone if you forget to take an injection, and then take another before necessary. Overdoses can also be caused by accidentally injecting too much, exercising vigioursly without changing the dosage of insulin taken, or even forgetting to eat. If you realise you may have overdosed on insulin, you should seek medical attention immediately. Continue reading >>