Authors
V Balachandran, MD, MNAMS, FRCP (EDIN), FACC (USA), DIP.DIAB, FICP, FISC, FCSI, Chief Physician, Cardio-Diabetology, Dr.Nair’s Hospital, Kollam, Kerala.
Abstract
Background: Massive overdose of antidiabetic medications or insulin, whether accidental or suicidal, presents significant challenges in emergency settings, requiring prompt recognition, management of metabolic derangements, avoidance of rebound hypoglycemia, and prolonged monitoring.
Case Presentation: This report describes a 65-year-old female who presented unconscious after a suicidal attempt involving a massive overdose of 1860 units of Humalog Mix insulin and 20 tablets of Glucored (Glibenclamide + Metformin). She was a known case of chronic diabetes with insulin resistance.
Management: The patient was managed efficiently with continuous glucose infusion, Octreotide Acetate, Potassium Chloride, and NaHCO3 over four days until serum insulin levels stabilized.
Discussion: The case highlights the rarity of combined insulin and sulfonylurea/metformin overdose, particularly fatal cases from India. Diagnostic considerations for hypoglycemia, including insulin-to-C-peptide molar ratio, and therapeutic options like Octreotide are discussed. The importance of prolonged monitoring is emphasized.
Conclusion: This unique case underscores the complexities of managing severe antidiabetic medication overdose and the need for comprehensive, sustained care.