White Mary, Zacharin Margaret R, Werther George A, Cameron Fergus J
Department of Endocrinology and Diabetes, The Murdoch Children's Research Institute at The Royal Children's Hospital, Parkville, Australia.
Pediatr Diabetes. 2016 Feb;17(1):66-9. doi: 10.1111/pedi.12210. Epub 2014 Sep 17.
Massive insulin overdose may be associated with unpredictable and prolonged hypoglycemia. Concerns surrounding the potential provocation of insulin release from beta cells have previously prevented the use of intravenous glucagon as an adjunct to infusion of dextrose in this situation. We describe the case of a 15-yr-old boy with type 1 diabetes mellitus (T1DM) who presented with profound hypoglycemia following an overdose of an unknown quantity of premixed insulin. Owing to an increasing dextrose requirement and a dependence on hourly intramuscular glucagon injections, a continuous intravenous infusion of glucagon was commenced which successfully avoided the requirement for central venous access or concentrated dextrose infusion. Nausea was managed with anti-emetics. Intramuscular and subcutaneous glucagon is effective in the management of refractory and severe hypoglycemia in youth with both T1DM and hyperinsulinism. Concerns regarding the precipitation of rebound hypoglycemia with the use of intravenous glucagon do not relate to those with T1DM. This treatment option may be a useful adjunct in the management of insulin overdose in youth with T1DM and may avoid the requirement for invasive central venous access placement.
大量胰岛素过量使用可能会导致不可预测的长时间低血糖。此前，由于担心β细胞释放胰岛素的潜在诱因，在这种情况下一直未将静脉注射胰高血糖素作为葡萄糖输注的辅助手段。我们描述了一名15岁1型糖尿病（T1DM）男孩的病例，他在过量注射未知剂量的预混胰岛素后出现严重低血糖。由于对葡萄糖的需求不断增加且依赖每小时一次的肌肉注射胰高血糖素，于是开始持续静脉输注胰高血糖素，这成功避免了中心静脉置管或高浓度葡萄糖输注的需求。恶心症状通过使用止吐药进行处理。肌肉注射和皮下注射胰高血糖素在治疗患有T1DM和高胰岛素血症的青少年难治性和严重低血糖方面是有效的。对于使用静脉注射胰高血糖素导致反弹性低血糖的担忧与T1DM患者无关。这种治疗选择可能是治疗T1DM青少年胰岛素过量的有用辅助手段，并且可以避免进行侵入性中心静脉置管。
