1455 A 10-year review of insulin-related enquiries to the UK National Poisons Information Service (NPIS). Issue 12 (22nd November 2022)

• Record Type: Journal Article
• Authors: Moyns, Emma; Ferner, Robin; Euan, Sandilands; Gray, Laurence; Thanacoody, Ruben; Bradberry, Sally
• Is Part Of: Emergency medicine journal. Volume 39:Issue 12(2022)
• Page Start: A988
• Page End: A988
• Publication Date: 2022-11-22
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2022-RCEM2.46
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Aims, Objectives and Background: More than 4.9 million people in the UK have diabetes, and sufferers are at increased risk of depression. 1 We reviewed enquiries to the NPIS about insulin overdose. Method and Design: Retrospective analysis of enquiries between 1 November 2011 and 31 October 2021. Results and Conclusion: We received 1195 enquiries involving insulin. Further analysis was limited to the 169 enquiries involving insulin only (90.5% via injection). Most enquiries (88%) concerned adults ≥ 18 years. There were 34 non-diabetic and 98 diabetic patients: 32 Type 1, 10 Type 2, and 56 type undocumented. Exposures were intentional (n=114, 68%), from therapeutic error (n=28), accidental (n=16) or circumstances unknown (n=11). Long-acting insulins were involved in 71 cases, and the highest dose was 20000 units ( table 1 ). The lowest recorded blood glucose concentration (mmol/L) at the time of the enquiry was in the range 0–0.9 (n=7), 1.0–1.9 (n=29), 2.0–2.9 (n=25), 3.0–3.9 (n=12), >4.0 (n=14). Hypokalaemia (defined as K+<3.5 mmol/L) was noted in 26 (n=15%) enquiries. The maximum Poisoning Severity 2 (n=162) was graded: none (n=55), minor (n=29), moderate (n=44), and severe (n=34). Treatments given prior to contacting the NPIS were IV glucose (n=91, 54%), IV/IM glucagon (n=26, 15%), IV octreotide (n=6, 4%) and IV corticosteroids (n=2, 1%). No patient underwent surgical excision of the injection site. Long-acting insulins accounted for 5/6 cases where octreotide was given. Conclusions: Hypoglycaemia following insulin overdose was mostly managed satisfactorily by intravenous glucose infusion, with glucagon used occasionally. The role of octreotide and corticosteroids was unclear. Approximately 20% of cases were severe, especially following overdose of medium- and long-acting insulins; we recorded no fatalities. References: https://www.diabetes.org.uk/professionals/position-statements-reports/statistics. Accessed February 2022. Persson HE, Sjöberg GK, Haines JA, De Garbino JP. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol 1998; 36 : 205–213.