Insulin degludec overdose may lead to long-lasting hypoglycaemia through its markedly prolonged half-life.

Abstract

BACKGROUND:

Overdose of insulin often causes long-lasting severe hypoglycaemia. Insulin degludec has the longest duration of action among the available insulin products; thus, an overdose of insulin degludec can lead to long-lasting hypoglycaemia. In the present paper, we report the case of a woman with long-lasting hypoglycaemia attributable to insulin degludec overdose and markedly prolonged insulin degludec half-life.

CASE REPORT:

A 64-year-old woman with Type 2 diabetes receiving insulin therapy was taken to an emergency department because of disturbed consciousness 21 h after self-injection of 300 units of insulin degludec (4.34 units/kg). Her plasma glucose level was 2.3 mmol/l. She received repeated intravenous boluses of dextrose for 43 h with continuous intravenous dextrose infusion, but no improvement in long-lasting hypoglycaemia or consciousness was observed. Considering the possibility of adrenal insufficiency, intravenous dexamethasone was administered, and her plasma glucose levels subsequently remained above 5.5 mmol/l without intravenous dextrose boluses. She gradually regained consciousness. A total of 34 h after the overdose, her plasma immunoreactive insulin levels were markedly increased and then gradually declined over ~400 h. The insulin degludec half-life was 40.76 h.

CONCLUSION:

Although the reported half-life of insulin degludec in the body is ~25 h when administered in standard doses (0.4-0.8 units/kg), no study has investigated its half-life after overdose. In the present case, the half-life of insulin degludec was ~1.6 times longer than that observed with standard doses, probably leading to long-lasting hypoglycaemia. Physicians should be aware of the possibility of unexpected long-lasting severe hypoglycaemia resulting from insulin degludec overdose.

• Authors: J Uchida, Y Oikawa, T Katsuki, H Takeda, A Shimada, T Kawai
• Journal: Diabetic medicine : a journal of the British Diabetic Association (Diabet Med) Vol. 35 Issue 2 Pg. 277-280 (02 2018) ISSN: 1464-5491 [Electronic] England
• PMID: 29178371 (Publication Type: Case Reports)
• Copyright: © 2017 Diabetes UK.

Chemical References

• Hypoglycemic Agents
• Insulin, Long-Acting
• insulin degludec

Topics

• Diabetes Mellitus, Type 2 (drug therapy)
• Drug Overdose
• Female
• Humans
• Hypoglycemia (chemically induced)
• Hypoglycemic Agents (pharmacokinetics, poisoning)
• Insulin, Long-Acting (pharmacokinetics, poisoning)
• Middle Aged