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Overdoses of insulin glargine (Lantus) are rarely reported in the literature. In fact, there are only 6 case reports. We recently had a patient in our ED who was hypoglycemic from insulin glargine. The hypoglycemic episode was quite prolonged (> 24 hours) in the ED before being the patient was transferred to the MICU. Here are a few points to remember:
- Insulin glargine does not peak; it was designed to mimic basal islet cell insulin secretion.
- In the therapeutic setting, its effects can last up to about 24 hours. In overdose the hypoglycemic effects have been reported to last up to 60-130 hours!
- Be prepared to give IV dextrose 5% or 10% infusion for the duration of the patient's hypoglycemic effect. This can be supplemented with food.
- Octreotide will be ineffective for exogenous insulin poisonings because its effect comes from its ability to suppress insulin secretion from the pancreas.