title: Acute hepatic injury following treatment of a long-acting insulin analogue overdose necessitating urgent insulin depot excision.
abstract: BACKGROUND
  A 26-year-old man with Type 1 diabetes presented with an overdose of 4800 units of the long-acting insulin analogue, glargine (Lantus). Glucose supplementation of approximately 800 g/day was associated with acute hepatic injury.
  
  
  METHODS
  On day 4, a depot of insulin was excised from the patient's abdominal wall; this was followed by a reduction in his glucose requirements and improvement in liver function.
  
  
  CONCLUSIONS
  This report highlights the risk of acute hepatic injury during the treatment of insulin overdose and the importance of careful glucose supplementation. It also demonstrates how earlier excision of an insulin depot could potentially prevent this problem and hasten recovery.
authors.affiliation: Department of Diabetes and Endocrinology, Northern General Hospital, Sheffield, UK.
authors.forename: D
authors.initials: D
authors.lastname: Warriner
authors.forename: M
authors.initials: M
authors.lastname: Debono
authors.forename: R A
authors.initials: RA
authors.lastname: Gandhi
authors.forename: E
authors.initials: E
authors.lastname: Chong
authors.forename: F
authors.initials: F
authors.lastname: Creagh
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D020878:Device Removal; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D062787:Drug Overdose; D005947:Glucose / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000009:adverse effects*; D008099:Liver / Q000187:drug effects* / Q000601:surgery; D008297:Male; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; C018503:insulin, depot-; D000069036:Insulin Glargine; D005947:Glucose