Title: Persistently elevated serum insulin levels after the discontinuation of high dose insulin therapy<br/>Author: Hong Kim<br/><a href='http://umem.org/profiles/faculty/526/'>[Click to email author]</a><hr/><p>
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High dose insulin (HDI) therapy is commonly used in patients with severe beta-adrenergic antagonist and calcium channel antagonist overdose. Hypoglycemia and hypokalemia are commonly known complication of HDI therapy. However, kinetics of insulin in patients who received HDI therapy is unknown.</p>
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A 51 year-old man with amlodipine overdose was infused HDI (10 unit/kg/hr) for 37 hours; Serial serum insulin levels were drawn after discontinuation of HDI.</p>
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Serum insulin levels are shown in below table</p>
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<img alt="Table
Description automatically generated" height="202" src="blob:https://umem.org/0b4c62f5-86dc-40de-903a-bc675cb8d143" width="393" /></p>
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The serum insulin level remained significantly elevated during the first 24 hours (normal range: 2.6-24.9 microU/mL) and gradually decreased over 6 days.</p>
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<strong>Conclusion</strong></p>
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The supraphysiologic insulin levels persist after discontinuation of HDI where patient may continue to experience hypoglycemia</li>
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These elevated insulin level may allow for more rapid titration or simply discontinue HDI when hemodynamic stability is achieved.</li>
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<fieldset><legend>References</legend>
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Corcoran JN et al. Persistent hyperinsulinemia following high-dose insulin therapy: a case report. J Med Toxicol 2020;16:465-469.</p>
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