Clinical toxicology (Philadelphia, Pa.) · 2026
Serial insulin and C-peptide concentrations following high-dose insulin for the treatment of drug poisoning: a consecutive case series.
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Nic Ionmhain Úna, Coulson Lori, Roberts Darren M
Аннотация
INTRODUCTION: High-dose insulin is a treatment for poisoning-induced cardiogenic shock. There is a risk of hypoglycaemia after discontinuing high-dose insulin due to persistent hyperinsulinaemia. The pharmacokinetics of insulin after discontinuing high-dose insulin are poorly defined, with previous publications reporting prolonged elimination half-lives (up to 18.8 h).
METHODS: We conducted a consecutive case series in poisoned patients treated with high-dose insulin. Serial insulin and C-peptide concentrations were measured after discontinuing high-dose insulin. The apparent elimination half-life of insulin was calculated using non-linear regression or simplified pharmacokinetic methods when data were limited.
RESULTS: We identified 10 patients. One case had pre-existing type 2 diabetes mellitus. Five cases developed acute kidney injury, and three of these cases were treated with continuous kidney replacement therapy. Hypoglycaemia did not occur after discontinuing high-dose insulin. The median apparent elimination half-life of insulin was 1.8 h (IQR 1.4-4.0 h; range 1.23-9.8 h). The longest half-life was in the patient with type 2 diabetes mellitus who also developed acute kidney injury. C-peptide and blood glucose concentrations varied together despite hyperinsulinaemia. No cases received octreotide.
DISCUSSION: The elimination half-life of insulin was relatively short in our study compared to previous reports and was not impacted by insulin dosage or duration, or kidney disease. There was endogenous insulin release despite hyperinsulinaemia, and C-peptide concentrations were mostly in established reference ranges, suggesting that dextrose supplementation was mostly not excessive. Resolution of hyperinsulinaemia typically occurred within 24 h of discontinuing high-dose insulin. During dextrose weaning, measuring serial C-peptide concentrations may identify excessive carbohydrate administration. Future research should assess how comorbidities such as diabetes mellitus and kidney disease influence insulin clearance.
CONCLUSIONS: This study identified a shorter insulin elimination half-life after discontinuing high-dose insulin than previously reported. Measuring serial insulin and C-peptide concentrations may guide clinical decisions, including dextrose weaning and confirm resolution of hyperinsulinaemia.
METHODS: We conducted a consecutive case series in poisoned patients treated with high-dose insulin. Serial insulin and C-peptide concentrations were measured after discontinuing high-dose insulin. The apparent elimination half-life of insulin was calculated using non-linear regression or simplified pharmacokinetic methods when data were limited.
RESULTS: We identified 10 patients. One case had pre-existing type 2 diabetes mellitus. Five cases developed acute kidney injury, and three of these cases were treated with continuous kidney replacement therapy. Hypoglycaemia did not occur after discontinuing high-dose insulin. The median apparent elimination half-life of insulin was 1.8 h (IQR 1.4-4.0 h; range 1.23-9.8 h). The longest half-life was in the patient with type 2 diabetes mellitus who also developed acute kidney injury. C-peptide and blood glucose concentrations varied together despite hyperinsulinaemia. No cases received octreotide.
DISCUSSION: The elimination half-life of insulin was relatively short in our study compared to previous reports and was not impacted by insulin dosage or duration, or kidney disease. There was endogenous insulin release despite hyperinsulinaemia, and C-peptide concentrations were mostly in established reference ranges, suggesting that dextrose supplementation was mostly not excessive. Resolution of hyperinsulinaemia typically occurred within 24 h of discontinuing high-dose insulin. During dextrose weaning, measuring serial C-peptide concentrations may identify excessive carbohydrate administration. Future research should assess how comorbidities such as diabetes mellitus and kidney disease influence insulin clearance.
CONCLUSIONS: This study identified a shorter insulin elimination half-life after discontinuing high-dose insulin than previously reported. Measuring serial insulin and C-peptide concentrations may guide clinical decisions, including dextrose weaning and confirm resolution of hyperinsulinaemia.