1455 A 10-year review of insulin-related enquiries to the UK National Poisons Information Service (NPIS)

Aims, Objectives and BackgroundMore than 4.9 million people in the UK have diabetes, and sufferers are at increased risk of depression.1We reviewed enquiries to the NPIS about insulin overdose.Method and DesignRetrospective analysis of enquiries between 1 November 2011 and 31 October 2021.Results and ConclusionWe 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 Severity2(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.Abstract 1455 Table 1Details of dose, insulin type, nadir blood glucose concentration, and Poisoning Severity Score in 169 cases of insulin poisoning reported to the UK National Poisons Information Service in the ten years to 31st October 2021. Ø = unrecordableInsulin type*Median dose Units (range)Lowestblood glucoseconcnmmol/L (mg/dL)Known diabeticpatientsMaximum poisoning severityModeraten% of all moderateSeveren% of all severeLong acting (N=71)600 (10–20000)Ø492352%1441%Medium acting (N=24)900 (60–4500)0.6 (11)11818%721%Short acting (N=14)75 (28–2000)1.6 (29)737%13%Ultrashort acting (N=35)180 (1.5–4800)1 (18)231023%515%Unknown (N=18)188 (45–400)Ø800%721%Canine (N=7)20 (7–1600)4.2 (76)000%00%*Where two or more insulin types or mixtures were involved (n=55, 32.5%), the longest-acting component was counted.ConclusionsHypoglycaemia 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.Referenceshttps://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 Toxicol1998;36: 205–213.