Specific substancesAntidiabetic drugs
Section snippets
Insulin
Insulin modifies glucose transporter function via its tyrosine kinase-linked receptor. Parenteral administration can cause profound hypoglycaemia and activation of neurohormonal counter-regulatory mechanisms. Overdose can be associated with a significantly longer duration of action than therapeutic doses. A large subcutaneous bolus of insulin, including short-acting formulations, can give rise to prolonged systemic absorption over many hours or days. Inhaled insulin has limited bioavailability
Clinical features
Poisoning by sulfonylureas, biguanides and insulin is associated with moderate to severe poisoning in 4.6%, 12.2% and 14.7% of cases, respectively, and with fatal poisoning in 0.9%, 6.1% and 3.6%, respectively.5
Insulin and sulfonylurea overdose can cause significant hypoglycaemia. There are few published data concerning the effects of meglitinides or SGLT2 inhibitors in overdose, but these are expected to cause significant hypoglycaemia, based upon their pharmacological mechanisms.6 The
Management
Hypoglycaemia should be reversed by administration of intravenous glucose (dextrose) 10–20%, aiming to achieve a target plasma glucose concentration of ≥4 mmol/litre (higher target concentrations may be needed to avoid symptoms in some patients with poorly controlled diabetes). Hypoglycaemia after insulin or antidiabetic drug overdose can persist for much a longer duration than expected after therapeutic doses.7 Prolonged intravenous infusions can be required; these are associated with a risk
References (13)
- et al.
Octreotide reverses hyperinsulinemia and prevents hypoglycemia induced by sulfonylurea overdoses
J Clin Endocrinol Metab
(1993) - et al.
The antihyperglycaemic effect of metformin: therapeutic and cellular mechanisms
Drugs
(1999) Pattern of thiazolidinedione exposures reported to Texas poison centers during 1998–2004
J Toxicol Environ Health
(2006)- et al.
A retrospective review of isolated gliptin-exposure cases reported to a state poison control system
Clin Toxicol
(2014) - et al.
Antidiabetic medications in overdose: a comparison of the inquiries made to a regional poisons unit regarding original sulfonylureas, biguanides and insulin
Int J Clin Pharmacol Ther
(2006) - et al.
Hypoglycemia following a nateglinide overdose in a suicide attempt
Diabetes Care
(2005)
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