Insulin detemir/alcohol interaction
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Hypoglycaemia following overdose: case report A 52-year-old man developed hypoglycaemia following an overdose of insulin detemir [Levemir] and concurrent use of alcohol. The man was found unconscious, and presented 2 hours after an intentional overdose of insulin detemir. He had injected 2100U of insulin detemir at multiple points on his abdomen, chest and thighs, and concurrently ingested approximately 450mL of whisky (40% alcohol). He had diabetes mellitus and was prescribed insulin detemir 18U once daily, as well as metformin. On presentation, examination revealed a Glasgow coma score scale of 3/15. Tests revealed a capillary blood glucose level of 2.6 mmol/L and an ethanol concentration of 104 mg/L (reference range 0–9 mg/L). The man was admitted, and received dextrose, potassium chloride, glucose, glucagon and fluids. His GCS gradually improved to 13/15. He developed multiple hypoglycaemic episodes, and experienced his final episode 41 hours after overdose. Author comment: "The long duration of action of Levemir and concurrent alcohol usage may have contributed to the persistent hypoglycaemic episodes which lasted 41 hours in this case. Alcohol is associated with increased sensitivity to insulin, possibly through an increase in adiponectin and a subsequent decrease in TNF-α." Oduru M, et al. Massive Levemir (long-acting) insulin overdose: Case report. Case Reports in Medicine 2012: [3 pages], No. 904841, 2012. Available from: URL: 803079527 http://dx.doi.org/10.1155/2012/904841 - United Kingdom
0114-9954/10/1427-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 10 Nov 2012 No. 1427
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