Abstract Octreotide is a somatostatin analog that binds to somatostatin receptors and exerts a range of inhibitory effects on hormonal secretion and cellular activity. These effects include inhibition of gastrin, insulin, glucagon, growth hormone, cholecystokinin, thyroid-stimulating hormone, serotonin, and substance P. It is commonly utilized to treat neuroendocrine tumors (insulinoma), growth hormone excess, and variceal bleeding. Octreotide has also been found to be useful in the treatment of sulfonylurea overdoses, as it inhibits the release of insulin from pancreatic beta cells, preventing hypoglycemia. This mechanism works due to sulfonylureas ability to stimulate endogenous insulin release. While the role in inhibiting endogenous insulin is clear, octreotide’s role in excessive exogenous insulin overdoses is a topic requiring further investigation, as it is not capable of suppressing the effects of exogenous insulin, but may play a role in bettering patient outcomes through alternative mechanisms. Here we present a case of a 41 year old man, who is a non-diabetic, that was treated with an Octreotide drip in the setting of a suicide attempt via intentional overdose of subcutaneous basal and bolus insulin. A 41-year-old man with a medical history of GERD, obesity, unmedicated bipolar disorder, and recurrent major depression presented to the emergency department after self-injecting 400 units of insulin aspart (Novolog U-100) in a suicide attempt. His dietary intake prior to the event was unknown. Emergency medical services recorded an initial blood glucose of 26 mg/dL. Poison control was contacted and recommended hourly glucose monitoring, encouragement of oral intake, and initiation of an octreotide infusion. The patient received 1 mg of glucagon and 100 mcg of octreotide as a single injection, followed by an octreotide infusion at 10 mL/hr with a concurrent dextrose drip. Poison control noted that, given the magnitude of the insulin overdose, significant fluctuations in blood glucose were anticipated and that octreotide would help stabilize pancreatic insulin secretion. The patient was admitted to the intensive care unit for close monitoring. He was stable for discharge to psychiatric inpatient hospitalization two days later. Exogenous insulin overdose remains a difficult clinical scenario, often requiring prolonged glucose supplementation. While dextrose administration with glucagon as needed are still the first line modalities of exogenous insulin overdose; octreotide can be utilized to supplement the treatment protocol. It should be noted that octreotide will only have utility for insulin overdoses in non-diabetics or diabetics with insulin resistance rather than type I pathophysiology. This abstract is funded by: None
Al-Assi et al. (Fri,) studied this question.