Refractory Hypoglycemia due to Humulin

Abstract

Humulin 70/30 insulin is an intermediate acting medication used for treatment diabetes mellitus. According to systematic review and there have been forty four case reports of overdoses with different types of insulin. We present a unique case of insulin Humulin 70/30 overdose due to suicidal attempt that presented with persistent hypoglycemia and required prolonged hospital treatment. A47 years old female patient presented to the emergency department due to decreased level of consciousness after self -administration of 2000 international unit Humulin insulin 70/30 suicidal attempt. In the emergency department patient treated with 250 ml D10% then shifted to the medical department. The patient continue treatment with dextrose 10% 200 ml/hour as continuous infusion, unfractionated heparin 7500 international unit/12 hour, hydrocortisone 100mg /6 hours, octreotide 100 microgram /8 and glucagon 1 mg . On the fourth day all medication and D10% stopped and the patient still under observation then discharged on will general condition without hypoglycemia attacks. A single high overdose of Humulin insulin can present with prolonged persistent hypoglycemia that is refractory to D10% alone. All physicians should know the guidelines to treat severe form of hypoglycemia and when to admit into medical department or intensive care unit with follow up for blood glucose and serum electrolyte monitoring.