From the Guidelines
The best medicine for insulin overdose is fast-acting glucose or glucagon, with glucagon being the primary treatment for severe cases or unconscious patients, as recommended by recent guidelines 1.
Treatment Approach
For conscious patients who can swallow safely, oral glucose sources like juice, regular soda, honey, or glucose tablets should be given immediately (15-20 grams of carbohydrates), followed by a more substantial snack containing protein and complex carbohydrates.
- Key considerations:
- For severe cases or unconscious patients, injectable glucagon is the primary treatment, available as GlucaGen or Gvoke (1 mg for adults, 0.5 mg for children under 25kg) 1.
- Glucagon works by stimulating the liver to release stored glucose into the bloodstream.
- In hospital settings, intravenous dextrose (D50W) may be administered.
Monitoring and Follow-Up
After initial treatment, blood glucose should be monitored frequently as the effects of insulin can last for hours.
- Important points:
- Patients on long-acting insulin may need extended monitoring and glucose supplementation.
- Anyone experiencing an insulin overdose should seek immediate medical attention even if symptoms improve with home treatment, as delayed hypoglycemia can occur, highlighting the importance of prompt medical intervention 1.
Guideline Recommendations
Recent guidelines emphasize the importance of appropriate insulin regimens in the hospital setting, discouraging the sole use of sliding-scale insulin and recommending basal or basal-plus-correction regimens for non-critically ill patients 1.
- Key recommendations:
- Basal insulin or a basal plus bolus correction insulin regimen is preferred for patients with poor oral intake or those taking nothing by mouth.
- An insulin regimen with basal, prandial, and correction components is preferred for patients with good nutritional intake.
From the FDA Drug Label
INDICATIONS AND USAGE 50% Dextrose Injection is indicated in the treatment of insulin hypoglycemia (hyperinsulinemia or insulin shock) to restore blood glucose levels. In insulin-induced hypoglycemia, intravenous injection of 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) is usually adequate.
The best medicine for insulin overdose is dextrose (IV), specifically 50% Dextrose Injection. It is indicated for the treatment of insulin hypoglycemia to restore blood glucose levels. The recommended dose is 10 to 25 grams of dextrose (20 to 50 mL of 50% dextrose) administered intravenously 2, 2.
From the Research
Treatment Options for Insulin Overdose
- The primary treatment for insulin overdose is intravenous (IV) glucose administration, which is used in almost all cases to restore and maintain euglycaemia 3, 4.
- Other treatment options that have been reported as beneficial include glucagon IV or intramuscular (IM), octreotide IV or IM, surgical excision, hydrocortisone IV, and oral intake of complex carbohydrates 3.
- In some cases, corticosteroids and mannitol may be given to mitigate hypoglycaemic brain damage 4.
Management of Complications
- Monitoring of electrolytes, hepatic, and cardiac functions is important in patients with insulin overdose, as complications such as hypokalaemia, hepatic disturbances, and cardiac toxicity can occur 3.
- In cases of high-dose insulin overdose, management of hyperkalemia following recovery from hypoglycaemia is a critical aspect of patient management 5.
- Conservative administration of potassium to correct initial hypokalemia may be considered in patients with high-dose insulin overdose 5.