误用超大剂量甘精胰岛素注射液致低血糖

Hypoglycemia caused by misuse of super-high-dose of insulin glargine injection

1例61岁女性2型糖尿病患者口服降糖药效果欠佳,遵医嘱加用甘精胰岛素注射液12 U每晚睡前皮下注射。因首次使用该药,未掌握使用方法,患者误将整支甘精胰岛素注射液300 U一次性皮下注射。用药后约3 h(凌晨2时)患者出现心慌、大汗、饥饿感等症状,指尖血糖为3.0 mmol/L,立即进食,症状缓解入睡;晨7时左右患者再次出现低血糖症状,指尖血糖为3.6 mmol/L,进食后症状缓解。当日未用降糖药,正常进餐并进食甜食。次日凌晨3时左右(甘精胰岛素注射液用药后约25 h)低血糖症状再次发作,指尖血糖为3.3 mmol/L,进食后症状好转。之后连续4 d未用降糖药,第5天起依次加用阿卡波糖、二甲双胍和甘精胰岛素注射液。观察1周,患者空腹指尖血糖5.9~6.7 mmol/L,餐后2 h指尖血糖6.0~7.7 mmol/L,未再出现低血糖症状。

A 61-year-old female patient with type 2 diabetes mellitus were prescribed a subcutaneous injection of insulin glargine 12 U at bedtime by the doctor because of the poor effect of oral hypoglycemic drugs.Because she used the drug for the first time and didn′t master the skills of use,a total of 300 U of insulin glargine was mistakenly injected subcutaneously at one time.About 3 hours later,the patient developed hypoglycemia symptoms such as palpitation,profuse sweating,hunger,and etc.The finger-prick blood glucose was 3.0 mmol/L and her symptoms improved after eating.No antidiabetic drugs were used that day and normal meals were taken,including sweet food.At about 3:00 am the next day(about 25 hours after the administration of insulin glargine injection),hypoglycemia recurred,the finger-prick blood glucose was 3.3 mmol/L,and the symptoms was improved after eating.On the 4 consecutive days after then,no hypoglycemic drugs were used.From the 5th day,acarbose,metformin and insulin glargine injection were added successively.One week later,the fasting finger-prick blood glucose was 5.9-6.7 mmol/L,and the finger-prick blood glucose was 6.0-7.7 mmol/L at 2 hours after meal.Hypoglycemia did not recur.