Critical low catastrophe: a case report of treatment-refractory hypoglycemia following overdose of long-acting insulin.

Critical low catastrophe: a case report of treatment-refractory hypoglycemia following overdose of long-acting insulin.

Sandooja R;Moorman JM;Priyadarshini KM;Detoya K

Case Reports in Endocrinology

2020

1905-07

Overdose of long-acting insulin can cause unpredictable hypoglycemia for prolonged periods of time. The initial treatment of hypoglycemia includes oral carbohydrate intake as able and/or parenteral dextrose infusion. Refractory hypoglycemia following these interventions presents a clinical challenge in the absence of clear guidelines for management. Octreotide has sometimes been used, but its use is generally limited to sulfonylurea overdose. In this case report, we present a case of refractory hypoglycemia following an overdose of 900 units of long-acting insulin glargine that failed to respond to usual modes of therapy mentioned above. Stress-dose corticosteroids were then initiated, followed by subsequent improvement in IV dextrose and glucagon requirements and blood glucose levels. Hence, corticosteroids may serve as an adjunctive therapy in managing hypoglycemia and can be considered earlier in the course of treatment in patients with refractory hypoglycemia to prevent volume overload, especially when large volumes of dextrose infusions are required.

BLOOD sugar; DEXTROSE; HYPOGLYCEMIA; INSULIN; INSULINOMA; PARENTERAL infusions

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8856022

2020

2090-6501 2090-651X 2090-651X

NEOMED College of Medicine

NEOMED College of Pharmacy

Department of Internal Medicine

Department of Pharmacy Practice

October 2020 List

Cleveland Clinic Akron General Hospital