{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T07:55:14Z","timestamp":1778399714085,"version":"3.51.4"},"reference-count":10,"publisher":"The Endocrine Society","issue":"5","license":[{"start":{"date-parts":[[2020,4,22]],"date-time":"2020-04-22T00:00:00Z","timestamp":1587513600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The use of high-concentration formulations of insulin is becoming more prevalent in the management of patients with diabetes mellitus. Situations of intentional overdose utilizing these agents pose particular challenges because of the altered pharmacology at large doses and the potential complications arising thereof.<\/jats:p><jats:p>A patient with type 1 diabetes mellitus self-administered 4050 units of high-concentration (300 units\/mL) insulin glargine, in addition to coingestants. The patient subsequently required 7 days of high-dose dextrose infusion in order to avoid hypoglycemia, with no further insulin needed during this period. The patient also developed reversible hepatic steatosis secondary to the prolonged use of high-dose dextrose.<\/jats:p><jats:p>Owing to the altered pharmacology of high-concentration insulin glargine when administered at large doses in cases of intentional overdose, patients are likely to require a much longer period of supplemental dextrose support than may otherwise be expected when these agents are used at therapeutic doses. The complication of hepatic injury in the form of steatosis also needs to be considered in these patients, and should prompt the use of adaptive prescriptions of intravenous dextrose where possible.<\/jats:p>","DOI":"10.1210\/jendso\/bvz020","type":"journal-article","created":{"date-parts":[[2020,4,22]],"date-time":"2020-04-22T17:25:45Z","timestamp":1587576345000},"source":"Crossref","is-referenced-by-count":8,"title":["Case Report: High-concentration Insulin Glargine Overdose Complicated by Hepatic Steatosis"],"prefix":"10.1210","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6015-9051","authenticated-orcid":false,"given":"Ryan","family":"Endall","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology, Royal Hobart Hospital, Hobart, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"McCallum","sequence":"first","affiliation":[{"name":"School of Medicine, University of Tasmania, Hobart, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4748-9571","authenticated-orcid":false,"given":"John","family":"Burgess","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology, Royal Hobart Hospital, Hobart, Australia"},{"name":"School of Medicine, University of Tasmania, Hobart, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2020,4,22]]},"reference":[{"issue":"3","key":"2020042213254074800_CIT0001","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s40265-016-0541-z","article-title":"Insulin glargine 300 U\/mL: a review in diabetes mellitus","volume":"76","author":"Blair","year":"2016","journal-title":"Drugs."},{"issue":"8","key":"2020042213254074800_CIT0002","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1007\/s40265-014-0226-4","article-title":"The evolution of insulin glargine and its continuing contribution to diabetes care","volume":"74","author":"Hilgenfeld","year":"2014","journal-title":"Drugs."},{"issue":"4","key":"2020042213254074800_CIT0003","doi-asserted-by":"crossref","first-page":"637","DOI":"10.2337\/dc14-0006","article-title":"New insulin glargine 300 Units mL-1 provides a more even activity profile and prolonged glycemic control at steady state compared with insulin glargine 100 Units mL-1","volume":"38","author":"Becker","year":"2015","journal-title":"Diabetes Care."},{"issue":"5","key":"2020042213254074800_CIT0004","doi-asserted-by":"crossref","first-page":"644","DOI":"10.2337\/diacare.23.5.644","article-title":"Time-action profile of the long-acting insulin analog insulin glargine (HOE901) in comparison with those of NPH insulin and placebo","volume":"23","author":"Heinemann","year":"2000","journal-title":"Diabetes Care."},{"issue":"2","key":"2020042213254074800_CIT0005","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.jemermed.2012.11.099","article-title":"Octreotide for the treatment of hypoglycemia after insulin glargine overdose","volume":"45","author":"Groth","year":"2013","journal-title":"J Emerg Med."},{"issue":"5","key":"2020042213254074800_CIT0006","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/00005792-198509000-00004","article-title":"Insulin overdose in eight patients: insulin pharmacokinetics and review of the literature","volume":"64","author":"Arem","year":"1985","journal-title":"Medicine (Baltimore)."},{"issue":"1","key":"2020042213254074800_CIT0007","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s001340000763","article-title":"Acute hepatic steatosis complicating massive insulin overdose and excessive glucose administration","volume":"27","author":"Jolliet","year":"2001","journal-title":"Intensive Care Med."},{"key":"2020042213254074800_CIT0008","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1146\/annurev.nu.16.070196.002515","article-title":"Regulation of hepatic de novo lipogenesis in humans","volume":"16","author":"Hellerstein","year":"1996","journal-title":"Annu Rev Nutr."},{"issue":"4","key":"2020042213254074800_CIT0009","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1016\/S0168-8278(97)80256-5","article-title":"A new model of acute liver steatosis induced in rats by fasting followed by refeeding a high carbohydrate-fat free diet. Biochemical and morphological analysis","volume":"26","author":"Delzenne","year":"1997","journal-title":"J Hepatol."},{"issue":"1","key":"2020042213254074800_CIT0010","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jemermed.2007.02.038","article-title":"Lantus overdose: case presentation and management options","volume":"36","author":"Fuller","year":"2009","journal-title":"J Emerg Med."}],"container-title":["Journal of the Endocrine Society"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jes\/article-pdf\/4\/5\/bvz020\/33114483\/bvz020.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jes\/article-pdf\/4\/5\/bvz020\/33114483\/bvz020.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,22]],"date-time":"2022-10-22T02:09:35Z","timestamp":1666404575000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jes\/article\/doi\/10.1210\/jendso\/bvz020\/5823847"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,22]]},"references-count":10,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2020,5,1]]}},"URL":"https:\/\/doi.org\/10.1210\/jendso\/bvz020","relation":{},"ISSN":["2472-1972"],"issn-type":[{"value":"2472-1972","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,5]]},"published":{"date-parts":[[2020,4,22]]},"article-number":"bvz020"}}