ROLE OF STEROIDS IN REFRACTORY HYPOGLYCEMIA DUE TO AN OVERDOSE OF 10,000 UNITS OF INSULIN GLARGINE: A CASE REPORT AND LITERATURE REVIEW

ABSTRACT Objective: A massive overdose of insulin glargine is an emergent condition that causes prolonged and refractory hypoglycemia, which may lead to coma and even death. We present a case of an intentional overdose with the highest reported dose of 10,000 units of insulin glargine (Lantus®, 100 units/mL). In addition to the use of glucagon and octreotide, we report here the benefit of adding steroids to the regimen. Methods: The case report is accompanied by a review of the literature. Results: A 36-year-old female presented nearly 44 hours after a massive overdose of 10,000 units of insulin glargine. The patient was admitted to the intensive care unit and required continuous dextrose infusion for 150 hours along with frequent dextrose 50% boluses. Pharmacological therapies used included glucagon to promote glycogenolysis and gluconeogenesis, octreotide to prevent any endogenous insulin secretion from the pancreas, and steroids for their hyperglycemic effects. Although not much effect was noted on blo...