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引用次数: 0
摘要
胰岛素是 1 型糖尿病患者和一些 2 型糖尿病患者的必备药物。有趣的是,据报道,滥用胰岛素不仅是糖尿病患者的一种自杀方式,也是其亲属以及能够接触到胰岛素的医务人员和辅助医务人员的一种自杀方式。本评论旨在提高人们对故意过量使用胰岛素可能导致抑郁症及其并发症的认识,以及对这种情况的诊断和治疗的认识。胰岛素过量可能导致严重和长时间的低血糖、低血糖昏迷和死亡。此外,低钾血症、低镁血症、低磷血症和肝酶升高也很常见。糖尿病患者出现不明原因的长时间低血糖时,应怀疑胰岛素过量;非糖尿病患者出现低血糖时,也可能会使用糖尿病药物。胰岛素和 C 肽的比例有助于区分外源性胰岛素和内源性胰岛素。治疗的基础是在可能的情况下,连续数天及时输注浓缩葡萄糖,同时口服,并加强葡萄糖监测,以防止低血糖。此外,还建议监测血清电解质水平。最后,最重要的是进行精神评估,以便及早发现抑郁症和自杀倾向。
Intentional Insulin Overdose and Depression in Subjects with and Without Diabetes Mellitus: A Commentary.
Insulin is an essential medication for people with type 1 diabetes mellitus and for some people with type 2 diabetes. Interestingly, insulin abuse has been reported as a mode of suicide, not only among people with diabetes, but also among their relatives, and among medical and paramedical personnel who have access to insulin. The aim of the present commentary was to raise awareness of potential depression-related intentional insulin overdose and its complications, as well as of the diagnosis and treatment of this entity. Insulin overdose may lead to severe and prolonged hypoglycemia, hypoglycemic coma, and death. Moreover, hypokalemia, hypomagnesemia, hypophosphatemia, and elevated liver enzymes are common. Insulin overdose should be suspected among people with diabetes in case of unexplained prolonged hypoglycemia and among people without diabetes who exhibit hypoglycemia and may have access to diabetic medications. The ratio of insulin to C-peptide helps distinguish exogenous insulin administration from endogenous secretion. The cornerstone of therapy is prompt administration of concentrated glucose infusions for days with simultaneous oral intake, when possible, and intense glucose monitoring to prevent hypoglycemia. Moreover, monitoring of serum electrolyte levels is recommended. Finally, psychiatric evaluation aiming at early identification of depression and suicidality is of paramount importance.
期刊介绍:
Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged.
The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.