Acute hepatitis induced by insulin overdose and oral glucose administration in a child managed under a hybrid continuous care model.

Abstract

Summary: Acute hepatitis was reported in a 10-year-old male patient with type 1 diabetes, believed to be due to hepatic glycogenosis from insulin overdose and oral glucose administration. Liver function abnormalities, including increased ALT, AST, and GGT, were observed without any abnormality in liver ultrasound. After detailed investigation, it was discovered that the patient was dosing himself with additional insulin to induce hypoglycemia. Close monitoring by the GluCare.Health hybrid platform and CGM was done along with further education about insulin doses, hypoglycemia, and hyperglycemia treatment. No specific pharmacological treatment was needed to treat hepatitis and the patient's liver enzymes normalized with the GluCare continuous care model.

Learning points: Importance of hybrid care models: hybrid care models allow for continuous tracking, closing the feedback loop that is currently missing from traditional clinical practice, leading to better patient outcomes through continuous engagement, monitoring, and timely adjustments. Risk of hepatitis from glucose overload: excessive glucose intake following a significant insulin overdose can lead to hepatitis due to the overaccumulation of glycogen. Balancing glucose administration: while the risk of hypoglycemia-induced neurological damage is a major concern, glucose administration should be carefully adjusted based on closely monitored blood glucose levels. Awareness of acute hepatitis: acute hepatitis as a complication of substantial insulin overdose and excessive glucose administration is a rare occurrence that endocrinologists should be aware of. Importance of monitoring liver enzymes: specific treatment may not be necessary; however, monitoring liver enzymes is essential to ensure they return to normal levels. Challenges in diagnosing factitious insulin use: diagnosing factitious insulin use in children and adolescents is challenging, as many patients may deny it, and parents may find it hard to believe. Careful and sensitive questioning is necessary.