Overinsulinization – the frequent cause of unsatisfactory glycemic control: case reports

Overview

By means of case reports, we wish to draw attention to the “hyperinsulinemic” syndrome / hyperinsulinemia, i.e. treatment by excessive doses of insulin, which appears quite frequently in clinical practice, while being overlooked with equal frequency. Excessive insulin doses induce secondary insulin resistance and increased blood glucose levels, which may encourage further increase of insulin doses. The possibility of excessive insulin treatment should be primarily considered in situations where a daily insulin dose exceeds 1.0–1.2 IU/kg body weight (BW), the patient gains more weight than normally expected, he/she has frequent fluctuations in blood glucose levels (alternating hypo- and hyperglycemia), or blood glucose levels are permanently increased (typically within 13–17 mmol/l) and do not respond to further increase of insulin doses, or may get even worse, or hidden hypoglycemia appears with counterregulatory hyperglycemia. The solution consists in the gradual reduction of insulin doses (approximately 10–15 % of the total daily dose) once in 2–3 days until reaching a dose of 0.5–0.6 IU/kg BW, or according to the response of blood glucose levels. Should blood glucose levels be not adjusted, the patient cooperation should be reconsidered, or another cause should be sought, such as severe insulin resistance, chronic inflammation, endocrine causes or individual ineffectiveness of a specific insulin analogue in a particular patient to be replaced by another type of insulin.

Key words:
insulinotherapy, excessive insulin treatment, unsatisfactory glycemic control, overinsulinization

Received:
25. 4. 2017

Accepted:
9. 5. 2017