August 1977

Chronic Overtreatment With Insulin in Children and Adolescents

Author Affiliations

From the North Florida Regional Diabetes Program of the Children's Medical Services Program of the Department of Health and Rehabilitative Services of the State of Florida, and the Division of Genetics, Endocrinology and Metabolism of the Department of Pediatrics, University of Florida, Gainesville.

Am J Dis Child. 1977;131(8):881-885. doi:10.1001/archpedi.1977.02120210059012

• 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 frequent 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 stressinduced 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.

(Am J Dis Child 131:881-885, 1977)