一名55歲第2型糖尿病男性患者合併C型肝炎病毒抗體陽性。他自行注射480-600單位NovoMix®30預混型胰島素於右下腹部，2至3小時之後血糖顯示為53 mg/dL，救護人員為他靜脈注射D50W 40西西。至急診室後血糖顯示95mg/dL，給予靜脈注射D10W維持每小時60西西及補充鉀離子，一小時後血糖又降為61mg/dL，再次給予推注D50W 40西西並且提高D10W注射速率至每小時100西西及安排住院。病人意識清楚可自由進食。在住院的前30小時內，共有五次血糖小於100 mg/dL，每次血糖小於100 mg/dL則推注40西西D50W。實驗室數據顯示高乳酸性血症，低血鉀，低血磷，極高的胰島素水平(3946.3 mU/L)和低C胜肽值(C-peptide: 0.43 ng/mL)。最後一次低血糖發作(58 mg/dL)是在大量胰島素注射後的第33小時(住院後第2天凌晨5點)。低血糖症恢復後，給予病人平常使用的胰島素劑量以控制糖尿病並會診精神科醫生進行評估。

Intentional insulin overdose is uncommon in clinical practice. We report a man who attempted to commit suicide with NovoMix®30 insulin. The 55-year-old man was diagnosed with type 2 DM and hepatitis C. He injected himself with 480 to 600 units of premixed insulin (NovoMix®30) subcutaneously in the right lower abdomen between 8PM and 9PM after a quarrel with his family. Two to three hours later, ambulance staff found him with low blood sugar of 53 mg/dL. D50W (50% dextrose) 40 CC was given intravenously. At the emergency department, blood sugar was measured at 95 mg/dL. D10W (10% dextrose) was supplemented at a rate of 60 CC per hour intravenously. Potassium was supplemented due to hypokalemia (2.6 meq/L). One hour later, finger sugar was 61mg/dL. Additional bolus of glucose was given. Dextrose was titrated up to D10W 100 CC per hour. He recovered well and tolerated oral intake. Over the next 30 hours, five episodes of blood glucose less than 100 mg/dL occurred and 40 CC D50W of bolus was given each time. Laboratory data showed lactic acidosis, hypokalemia, hypophosphatemia, a very high insulin level of 3946.3 mU/L and low C-peptide of 0.43 ng/mL. The last episode of hypoglycemia (58 mg/ dL) was observed at 5AM on the 2nd day, upon the 33rd hour after insulin injection. Usual insulin doses were used for diabetes control after resolution of hypoglycemia. He was referred to a psychiatrist for further evaluation.