What is the treatment for insulin overdose?

Treatment of Insulin Overdose

The primary treatment for insulin overdose is immediate administration of oral or intravenous glucose, followed by continuous glucose monitoring and infusion to maintain euglycemia until the insulin effect subsides. 1

Initial Management

Immediate Interventions

• For conscious patients with mild hypoglycemia:

  • Administer 15-20g of oral fast-acting carbohydrates (juice, glucose tablets)
  • Recheck blood glucose after 15 minutes and repeat treatment if necessary

• For severe hypoglycemia with altered mental status or unconsciousness:

  • Administer IV dextrose: 25-50g (50 mL of 50% dextrose) as bolus 2
  • If IV access is unavailable, administer glucagon:
    • Adults and children >25kg: 1mg IM/SC
    • Children <25kg: 0.5mg IM/SC 3
  • Reassess in 15 minutes; may repeat glucagon dose if no response

Ongoing Management

Continuous Glucose Monitoring and Replacement

• Initiate continuous IV infusion of 10% or 20% dextrose 4
• Titrate infusion rate to maintain blood glucose between 100-250 mg/dL 2
• Monitor blood glucose every 15-30 minutes initially, then hourly once stable
• For prolonged insulin action (especially with long-acting analogs), expect treatment duration of 24-96 hours 4

Calculation of Glucose Requirements

• The amount of IV glucose required correlates with insulin dose:
  • Glucose (g) = 52 + (0.699 × insulin dose in units) 5
  • Duration of IV glucose therapy (hours) = 10.5 + (0.028 × insulin dose in units) 5

Special Considerations

Non-Diabetic Patients

• Non-diabetics are more likely to develop recurrent hypoglycemia due to endogenous insulin release triggered by exogenous glucose 5
• Consider octreotide (a somatostatin analog) to prevent rebound hypoglycemia:
  • Typical dose: 50-100 μg SC/IV every 6-12 hours 6

Long-Acting Insulin Analogs

• Overdoses of insulin detemir or glargine may cause hypoglycemia lasting 48-96 hours 4
• Consider surgical excision of injection site if identified early 4
• Monitoring serum insulin concentrations may help predict when effects will subside 7

Electrolyte Monitoring

• Monitor serum potassium levels as insulin promotes potassium entry into cells
• Target potassium levels of 2.5-2.8 mEq/L during treatment 2
• Avoid aggressive potassium repletion which may increase risk of arrhythmias 2

Hospital Disposition

• All patients with intentional insulin overdose require hospital admission
• Severe cases require ICU admission for continuous monitoring
• Psychiatric evaluation is necessary for intentional overdoses
• For diabetic patients, careful restart of diabetes treatment is required before discharge

Prevention of Recurrence

• All insulin users should carry medical identification
• Family members and caregivers of insulin-dependent patients should be trained in glucagon administration 2
• Insulin should be continued during illness even if the patient is unable to eat 2

Remember that the duration of treatment needed may be much longer than predicted by conventional insulin action times, particularly with long-acting insulin formulations.