Chronic overtreatment with insulin in children and adolescents
A. L. Rosenbloom and B. P. Giordano
We have recorded clues to the clinical recognition of chronic insulin
overdosage in 101 pediatric patients with diabetes mellitus, identified
predisposing circumstances, and reconsidered the traditional strategy of
slow reduction in insulin dose. Overtreatment occurred in 70%, overall, and
in 90% of those referred for instability; mean overdose was 38% of the
readjusted dose. The most common findings were frank hypoglycemic episodes,
polyuria/nocturia/enuresis despite increasing insulin dosage, excessive
appetite, hepatomegaly, weight gain, headaches, exercise intolerance,
marked variation in glucosuria, mood swings, and frequence bouts of rapidly
developing ketoacidosis. Overtreatment usually developed because of
attempts to achieve metabolic control using glucosuria as principal
criterion. One fourth of those observed became overtreated during periods
of emotional turmoil when need for increased insulin to counter
stress-induced hyperglycemia and ketosis led to chronic increase in dosage.
Persistent glucosuria/ketonuria and exacerbation of hypoglycemic symptoms
were more frequent with slow than with rapid reduction in insulin dosage.
