Ms. Long, a patient with type 2 diabetes, was prescribed 20 units of insulin, equivalent to 0,2 ml with a 1 ml U100 insulin syringe, for the morning and 22 units for the afternoon by a local hospital doctor. This time, Ms. Long drew 2 ml of insulin, equivalent to 200 units – 10 times the prescribed dose – because she used the wrong type of syringe.

She arrived at Tam Anh General Hospital, TP HCM, in a state of semi-consciousness, difficult to rouse, with a Glasgow Coma Scale score of 12/15, a slow heart rate, and low blood pressure (80/50 mmHg). Lab test results showed a significant drop in blood sugar and hypokalemia. Doctor Lam Van Hoang, Head of the Endocrinology and Diabetes Department, diagnosed the patient with severe hypoglycemia.

Ms. Long for a follow-up visit with Doctor Hoang. *Photo: Tam Anh General Hospital*

The patient received intravenous hypertonic glucose, glucose fluid infusion, and electrolyte and potassium replacement. Following treatment, Ms. Long's blood sugar levels increased, and her consciousness improved. She continued to be monitored in the Endocrinology and Diabetes Department, as an insulin overdose can lead to persistent side effects.

Doctor Hoang explained that an insulin overdose leads to sudden hypoglycemia because the hormone promotes excessive absorption and storage of glucose from the blood into muscles, the liver, and adipose tissue. Blood sugar levels are quickly depleted, and the liver cannot release glucose fast enough to compensate, resulting in a severe drop in blood sugar.

If sudden hypoglycemia is not treated promptly, it can deprive the brain of energy, leading to coma, irreversible neurological damage, cardiac arrhythmias, and a high risk of death. An insulin overdose can also cause electrolyte imbalances and hypokalemia as potassium is moved from the blood into cells.

An insulin pen is a handheld device resembling a pen, containing pre-dosed medication. A traditional syringe consists of a plastic barrel with measurement markings and an attached needle, requiring the user to draw insulin from a vial.

According to Doctor Hoang, incorrect or wrong-dose insulin injections are common among those using traditional syringes. Therefore, individuals with diabetes, especially older adults or those with mobility challenges, should use insulin pens, which are easier to use and cause less discomfort. If insulin in vials must be used, patients need to strictly follow their doctor's treatment instructions and injection guidelines. For 100 units/1 ml insulin vials, a 100 units/1 ml insulin needle should be purchased. For 40 units/1 ml insulin vials, a 40 units/1 ml insulin needle should be purchased.

Patients exhibiting symptoms such as trembling hands, sweating, confusion, drowsiness, or loss of consciousness need immediate medical attention at the nearest healthcare facility. Absolutely do not attempt to give food or drink to a semi-conscious patient to prevent choking.

Bach Duong

*Patient's name has been changed