Management overview for insulin poisoning

Insulin poisoning can cause prolonged hypoglycaemia. Management of insulin poisoning focuses on close monitoring of the blood glucose concentration and treatment of hypoglycaemia with glucose. In addition to glucose administration, encourage the patient to eat complex carbohydrates; this will decrease the overall glucose requirement.

The duration of observation required for patients with insulin poisoning is influenced by:

• the insulin formulation (eg ultrarapid-, rapid-, intermediate- and long-acting, and combined formulations); for more information on insulin formulations, see Action profiles of insulin formulations
• the site and number of injections—single large injections can have a depot effect
• whether the patient has diabetes.

In patients with diabetes, resolution of toxicity is apparent once the blood glucose concentration starts to rise. In patients without diabetes, the blood glucose concentration does not rise following the resolution of toxicity because the pancreas secretes endogenous insulin when the exogenous insulin has been eliminated. Weaning and cessation of glucose therapy in this setting is complex. Consult a clinical toxicologist.