Endocrine Abstracts

This is a case of an 18-year-old person living with Type 1 Diabetes, presenting with unusual severe hypoglycemic episodes, on insulin Detemir twice daily and insulin Aspart with meals. Episodes appeared prolonged in duration requiring IV glucose infusions with a total of four inpatient admissions. Intentional overdose was recurrently denied, and smart insulin pen downloads confirmed normal expected insulin dosing. Investigations included a Short Synacthen Test with a stimulated 30-minute cortisol of 678 nmol/l, negative insulin antibodies, suppressed insulin and c-peptide levels, a plasma 3 hydroxybutyrate level of 0.2 mmol/l and a potassium of 3.0 mmol/l on admission. Antibodies for coeliac were also negative and both IGF-1 and IGF-2 levels were in normal range. Eventually a second pen was found and downloaded, showing significant amounts of insulin dialed, including 309.5 units and 570 units on two separate occasions. The second dose had been administered during a hospital admission for severe hypoglycemia. He then admitted administering the above amount of insulin on a background of significant life stressors and history of self –harm. Samples stored for analogue insulin measurement in Cologne were no longer required with financial savings. This case highlights, how the smart insulin pen technology can be a tool in intentional insulin overdoses. Mental health support was the key to prevent an impending medical emergency in this scenario.