Overdoses of insulin glargine (Lantus) are rarely reported in the literature. In fact, there are only 6 case reports. We recently had a patient in our ED who was hypoglycemic from insulin glargine. The hypoglycemic episode was quite prolonged (> 24 hours) in the ED before being the patient was transferred to the MICU. Here are a few points to remember:
Insulin glargine does not peak; it was designed to mimic basal islet cell insulin secretion.
In the therapeutic setting, its effects can last up to about 24 hours. In overdose the hypoglycemic effects have been reported to last up to 60-130 hours!
Be prepared to give IV dextrose 5% or 10% infusion for the duration of the patient's hypoglycemic effect. This can be supplemented with food.
Octreotide will be ineffective for exogenous insulin poisonings because its effect comes from its ability to suppress insulin secretion from the pancreas.
