8002 A Dose Beyond Limits: Semaglutide and Insulin Overdose - A Novel Approach to Management

Abstract Disclosure: F.F. Foo: None. T. Amin: None. F. Farhat: None. P. Gonzalez: None. K. Hu: None. K. Chalasani: None. J. Cheng: None. R. Ong: None. M.S. Akula: None. R. Philip: None. S.W. Holland: None. Background: In the past decade, treatment of diabetes has expanded to include multiple classes of medication including GLP-1 agonists. Although newer medications offer better safety profiles, overdosing on these agents can have potentially fatal complications. Several cases of insulin overdose have been reported to date however, only a few cases of GLP-1 receptor agonist overdoses have been recorded and to our knowledge none have been reported on semaglutide specifically. We present a unique case of a patient who intentionally overdosed with massive amounts of both the injectable GLP-1 receptor agonist and multiple types of insulin and our approach to management. Case Presentation: This is a case of a 61 year old female with past medical history including depression, hypertension, stage 3 chronic kidney disease, and insulin dependent type 2 diabetes. She was brought by EMS to the emergency room after injecting herself with Toujeo Max 1800 units, Lantus 300 units, Humalog 300 units, and a pen of Ozempic (3mL). On initial EMS contact, the patient's blood glucose was 27 and she was given 50cc of D10W which improved her blood glucose to 110. Her admission was complicated by persistent hypoglycemia despite ongoing intravenous dextrose infusions, injections of octreotide and glucagon, and IV steroids. Given the long half life and massive dose of Toujeo, a decision was made to initiate hemodialysis to expedite insulin metabolism and removal. Insulin levels were monitored before and after dialysis to determine the efficacy of dialysis. After 1 session of dialysis insulin levels improved from 286.37 to 124.66 miU/mL and due to patient’s preference dialysis was discontinued. Following dialysis, the patient was able to be tapered off steroids and no longer required glucagon and octreotide injections. Her insulin levels continued to trend down daily and eventually she was resumed on her home basal - bolus insulin regimen. On day 10 of admission, she was deemed both medically and psychiatrically clear for discharge. She was sent home with a basal - bolus regimen, she was seen at our office for follow up and continues to do well. Conclusion: Newer diabetes medications and insulin formulations have become increasingly popular and physicians must remain vigilant in iden