Asymptomatic Subcutaneous Semaglutide Overdose: A Case Report and Literature Review

Semaglutide is a glucagon-like-peptide-1 receptor agonist (GLP-1 RA) that is approved for the treatment of type 2 diabetes mellitus (T2DM) and obesity. Common adverse drug reactions (ADR) of semaglutide include nausea, vomiting, abdominal pain, constipation, and diarrhea, which are often dose-dependent in nature. Select ADRs that are less common, but may result in more significant concerns, include development of acute pancreatitis, gallbladder and biliary tract diseases, acute kidney injury, and ileus. Limited clinical literature exists at present regarding management of GLP-1 RA overdose, particularly for subcutaneous semaglutide. This report describes an 80-year-old male with T2DM and mild cognitive impairment who self-administered subcutaneous semaglutide 1 mg daily over the span of 7 days. The patient denied any ADRs, including those related to gastrointestinal upset or hypoglycemia. Blood glucose readings from the patient's glucometer ranged from 100 - 180 mg/dL. The patient declined to present for medical evaluation until 5 weeks after the overdose incident. No clinically significant changes were noted in his renal function, hepatic function, nor his pancreatic enzymes upon laboratory follow-up. Published reports concerning GLP-1 RA overdoses describe mixed presentation of patients following such events. Treatments detailed in the case reports included primarily supportive care measures. Based on the mechanism of action of GLP-1 RAs, and those case reports detailed, we recommend close monitoring and supportive care in the form of providing antiemetics, correcting fluid and electrolyte imbalances from gastrointestinal losses, and monitoring for hypoglycemia in the event of an overdose.