SUN-620 Severe Hypoglycemia Following Accidental Intramuscular Injection of Regular Insulin

Abstract Disclosure: J. Saunders: None. A. Gabriely: None. Background/Objective Hypoglycemia is a life-threatening condition that requires rapid identification and treatment. This case examines a unique presentation of hypoglycemia in a non-diabetic patient following an accidental intramuscular injection of a large dose of insulin. Case Report A 48-year-old female presented to the hospital with sweating, palpitations, dizziness, tremors, and fatigue. She had a medical history of hypertension and gastroesophageal reflux disease, managed with Cozaar and Prilosec, respectively. Her symptoms began hours after she mistakenly injected 10 cc (1,000 units) of regular insulin intramuscularly instead of her usual Depo-Provera birth control injection. Initial evaluation revealed a plasma glucose level of 32 mg/dL and an insulin level of 231 mIU/mL, with a negative sulfonylurea screen. Her HbA1c was 5.4%. The patient was treated with a continuous intravenous dextrose infusion, and her glucose levels gradually normalized over 48 hours. A psychiatric evaluation ruled out deliberate self-harm. She was discharged on the third day of hospitalization with stable glucose levels, and follow-up confirmed sustained normoglycemia. Discussion This case highlights the severity of an insulin overdose in non-diabetic patients, emphasizing the risk of hypoglycemia due to excessive circulating insulin. Intramuscular insulin administration can further accelerate systemic absorption, necessitating aggressive monitoring and management. Differentiating accidental overdose from intentional overdose is critical in these situations. In this case, psychiatric assessment excluded deliberate self-harm. The successful reversal of prolonged hypoglycemia with intravenous dextrose infusion underscores its effectiveness in managing large insulin overdoses. The incident also underscores the importance of patient education regarding proper medication handling to prevent similar errors. Conclusion Accidental insulin overdose in non-diabetic patients can result in life-threatening hypoglycemia. Prompt recognition and appropriate management with intravenous dextrose infusion are essential for recovery. To prevent such incidents, healthcare providers must emphasize patient education on safe medication practices and handling. Presentation: Sunday, July 13, 2025