Accidentally ingesting insulin

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Accidentally ingesting insulin

Postby ArgonV » Thu Jun 04, 2009 9:45 pm UTC

Today at the university, I had a discussion with a few students from other disciplines. At a certain point we ended up talking about insulin. The question was: If you accidentally ingest insulin, you need direct medical attention.

Two of us, a chemistry and a physics student, thought you would need to call an ambulance. The biologist and me said that you'd be ok, as long as you ate a few sweet items, like a few cubes of sugar, a couple of candy bars or something similar.

We're talking about healthy, non-diabetic people here, and the quantity of insulin is just one or two units that (Type 1) diabetics use.

So? Who's right?
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Re: Accidentally ingesting insulin

Postby LTK » Thu Jun 04, 2009 9:53 pm UTC

Well, I'm guessing that insulin, being a hormone, would be rendered inactive by the low pH in the stomach acid, and further broken up in the digestive system so that by the time it reaches the cells with insulin receptors it's harmless. I'd have to have a graph of the hormone functionality against the pH to confirm that, though.

Edit:
Wikipedia on insulin wrote:Insulin is produced and stored in the body as a hexamer (a unit of six insulin molecules), while the active form is the monomer. The hexamer is an inactive form with long-term stability which serves as a way to keep the highly reactive insulin protected, yet readily available. The hexamer-monomer conversion is one of the central aspects of insulin formulations for injection. The hexamer is far more stable than the monomer, which is desirable for practical reasons, however the monomer is a much faster reacting drug because diffusion rate is inversely related to particle size.


We also used the method to investigate the self-association properties of insulin over a wide pH range. The equilibrium constant for the formation of dimers decreased only 6-fold over a 9.2 pH unit increase from pH 2 to 11.2 but almost 200-fold for the additional 1.5 pH unit increase from pH 11.2 to 12.7. We conclude that a residue of pK 12 is critical to the maintenance of the quaternary structure of insulin. We assign this role to the single B22-arginyl residue in insulin.


From http://diabetes.diabetesjournals.org/co ... 1.abstract . I'm not entirely sure what this implies, but I think they're saying that insulin in a hexagon, the stable form, is much more predominant in higher pH, which could mean that it's easily digested in acidic conditions.
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Re: Accidentally ingesting insulin

Postby ArgonV » Thu Jun 04, 2009 10:10 pm UTC

Yes, I agree that insulin would be destroyed in the stomach. That's why there aren't any insulin pills. I think :P

Ingesting was misleading, I agree. Let's just say, for whatever reason tickles your fancy, you inject 1-2 units of insulin into your bloodstream?
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Re: Accidentally ingesting insulin

Postby Minchandre » Thu Jun 04, 2009 10:19 pm UTC

ArgonV wrote:Yes, I agree that insulin would be destroyed in the stomach. That's why there aren't any insulin pills. I think :P

Ingesting was misleading, I agree. Let's just say, for whatever reason tickles your fancy, you inject 1-2 units of insulin into your bloodstream?


I'd go to the hospital just in case, but you'd probably be okay. Human insulin levels vary a lot throughout the day, and do spike to very high levels sometimes. Then again, it's been a couple years since I've had a class on hormones and stuff.
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Re: Accidentally ingesting insulin

Postby LTK » Thu Jun 04, 2009 10:22 pm UTC

ArgonV wrote:Yes, I agree that insulin would be destroyed in the stomach. That's why there aren't any insulin pills. I think :P

Ingesting was misleading, I agree. Let's just say, for whatever reason tickles your fancy, you inject 1-2 units of insulin into your bloodstream?


Well, in that case your blood sugar would dive down and hypoglycemia could be the result. There should be no lasting effects, since the liver removes the insulin from the bloodstream and adds glucagon to counter the effect, unless you don't eat anything for the rest of the day, after which you could get brain damaged, but I have no idea how long you would have to be off the sugar for that to happen. So, in short, when a healthy person injects insulin, he'll become tired and hungry, maybe start trembling and sweating, but there won't be any lasting effects.
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Re: Accidentally ingesting insulin

Postby Yakk » Thu Jun 04, 2009 10:29 pm UTC

I have seen quite bad reactions from diabetics (type 1) who inject an insulin dose and don't eat. As in, his brain function plummeted, his speech started slurring, balance suffered.

(I interrupted a house mate who was about to eat with a trip to a store -- he forgot he had already injected.)

I don't know how many doses he injected himself with, but I assume the usual amount. And I'm not aware that type 1 diabetics are particularly worse at dealing with insulin spikes than normal folks?
One of the painful things about our time is that those who feel certainty are stupid, and those with any imagination and understanding are filled with doubt and indecision - BR

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Re: Accidentally ingesting insulin

Postby mdyrud » Fri Jun 05, 2009 2:47 am UTC

Your response would depend heavily on how fast you treat it. If you immediately eat some sugary substance you should be fine. If you have a severe enough reaction, you will probably want to go to the hospital, as IIRC an overdose like that can lead to some nasty shock. I believe that was how insulin shock therapy worked for schizophrenics and the like.
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Re: Accidentally ingesting insulin

Postby qetzal » Fri Jun 05, 2009 3:27 am UTC

If you're only injecting 1-2 units, and if you are an adult of about average size (e.g. 70 kg), I don't think the effect would be very great. Some mild hypoglycemia, perhaps, especially if you're fasting, but that dose isn't likely have severe effects. (I think - I am not an MD!)

For example, here is a study where healthy volunteers were given subQ injections of 0.05 U/kg, which would be 3.5U for a 70 kg person. On average, their blood glucose levels dropped to ~ 3.2 - 3.5 mmol (normal is ~ 5.0 mmol or 90 mg/dL). That's low enough that you might feel a bit weak or light-headed, IIRC, but probably not enough to have severe effects for most people.

Once again, I am not an MD. DO NOT treat any of the above as an actual medical opinion - it' not! :wink:

P.S. Oral insulin would normally have no effect. It wouldn't survive the digestive system and wouldn't be absorbed in an active state. One or two companies have been trying to develop specially formulated oral versions of insulin, but I'm not sure how much progress they've made. Not enough for approval in the US, at least, though I think one product may actually be approved in some South American country.
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Re: Accidentally ingesting insulin

Postby iop » Fri Jun 05, 2009 4:06 am UTC

A strong enough overdose can kill. 1-2 units is not a strong enough overdose, but you should refrain from driving or operating heavy machinery.
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Re: Accidentally ingesting insulin

Postby Yggdrasil » Fri Jun 05, 2009 4:25 am UTC

If insulin could be taken into the bloodstream via oral ingestion, do you think type I diabetics would be taking insulin injections rather than just using insulin pills?
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Re: Accidentally ingesting insulin

Postby Carnildo » Fri Jun 05, 2009 8:27 am UTC

Yggdrasil wrote:If insulin could be taken into the bloodstream via oral ingestion, do you think type I diabetics would be taking insulin injections rather than just using insulin pills?

Yes. Injecting it gives a faster, more predictable response.
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Re: Accidentally ingesting insulin

Postby iop » Fri Jun 05, 2009 1:21 pm UTC

Carnildo wrote:
Yggdrasil wrote:If insulin could be taken into the bloodstream via oral ingestion, do you think type I diabetics would be taking insulin injections rather than just using insulin pills?

Yes. Injecting it gives a faster, more predictable response.

No. Injecting means that you have to reduce the number of insulin uptakes, which makes it much harder to get the right insulin level. Injecting means that you need to carry equipment with you. Injecting means that you have to be trained to do it properly (both for the procedure and to figure out the timing). Injecting is a lot more expensive. Injecting is limited to people who are physically able to do it.

Seriously, if you invent an insulin pill, you are rich.
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Re: Accidentally ingesting insulin

Postby Spudgun » Fri Jun 05, 2009 2:11 pm UTC

Given enough insulin you'll fall in to a coma, and a large amount would result in seizures. This is what happens in insulin shock therapy, as someone already mentioned.

Edit: No one noticed, right? ¬_¬
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Re: Accidentally ingesting insulin

Postby Qaanol » Fri Jun 05, 2009 3:01 pm UTC

Spudgun wrote:Given enough insulin you'll fall in to a comma

You will remain in the comma for a period. If the dose is large enough there may be damage to your colon, and perhaps your heart will come to a full stop unless you are brought to the hospital in a dash and put on a dieresis machine. For smaller doses, your speech may be slurred beyond the recognizable exclamation point. I do not recommend you seek an experimental answer to this question, mark my words.
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Re: Accidentally ingesting insulin

Postby sgt york » Fri Jun 05, 2009 3:57 pm UTC

Insulin is a dipeptide, and has 3 disulfide bonds, two of which hold the two different peptides together. These would get broken down pretty easily. And, of course, the peptides themselves would get chewed up by the digestive process as well.

It wouldn't have any effect on you.
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Re: Accidentally ingesting insulin

Postby BoomKing » Fri Jun 05, 2009 5:27 pm UTC

Qaanol wrote:
Spudgun wrote:Given enough insulin you'll fall in to a comma

You will remain in the comma for a period. If the dose is large enough there may be damage to your colon, and perhaps your heart will come to a full stop unless you are brought to the hospital in a dash and put on a dieresis machine. For smaller doses, your speech may be slurred beyond the recognizable exclamation point. I do not recommend you seek an experimental answer to this question, mark my words.


Heheh, well played.
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Re: Accidentally ingesting insulin

Postby ArgonV » Fri Jun 05, 2009 5:57 pm UTC

iop wrote:No. Injecting means that you have to reduce the number of insulin uptakes, which makes it much harder to get the right insulin level. Injecting means that you need to carry equipment with you. Injecting means that you have to be trained to do it properly (both for the procedure and to figure out the timing). Injecting is a lot more expensive. Injecting is limited to people who are physically able to do it.

Seriously, if you invent an insulin pill, you are rich.


Are you sure? Don't they have does pen-like syringes that can be set to inject the needed dose? That's what the device of a former classmate of mine looked like anyway. When she showed me how to do it, in case of hyperglycaemia, she told me to just prick one end in her and press the other end. She might've had something out of the ordinary though.
Also, isn't the timing real easy to figure out? The same girl had to have breakfast, lunch and dinner at approximately the same time every day (she had a leeway of about half an hour), so she didn't have any problems with her blood sugar.

And if you really want to get rich, invent a subdermal insulin-pump. No need to do anything yourself, except for refilling the reservoir from time to time.
Or gene therapy to repair the beta cells in the pancreas.
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Re: Accidentally ingesting insulin

Postby sgt york » Fri Jun 05, 2009 7:34 pm UTC

ArgonV wrote:And if you really want to get rich, invent a subdermal insulin-pump

Rich, sued, something like that. Money will change hands.
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Re: Accidentally ingesting insulin

Postby Terebrant » Sat Jun 06, 2009 12:01 am UTC

Not an M.D. either but I will try to give some answers.

For the first situation, I would say no one was right. If it was injected in the bloodstream (it is not that common unless there is already a KT) you probably would rapidly experience a mild hypoglycemia although not something dangerous and in a few hours at most would be ok, or you could drink a can of coca or similar and more than offset what you injected.

Yakk wrote:I don't know how many doses he injected himself with, but I assume the usual amount. And I'm not aware that type 1 diabetics are particularly worse at dealing with insulin spikes than normal folks?

The usual amount might change a lot if he follows a functional insulin treatment. Also, sometimes shallow hypoglycemia can be more debilitating.

It depends on the spike, natural spikes are still quite different from those used in diabetes so the comparison isn't easy. I looked at the study linked by qetzal and it looks like there is a difference from what I know about how type 1 diabetics reacts (they would have had a lower glycemia).

quetzal, there were tests to make the patient absorb it in a dissociated form, their results were not that great either.

Yggdrasil wrote:If insulin could be taken into the bloodstream via oral ingestion, do you think type I diabetics would be taking insulin injections rather than just using insulin pills?

It is too early to say but the advantage of injections at this time is that its effects are (very) well known.

iop wrote:No. Injecting means that you have to reduce the number of insulin uptakes, which makes it much harder to get the right insulin level.

Not necessarily, insulin pumps or various types of insulin + functional insulin treatment have sufficient observance.

iop wrote:Injecting means that you need to carry equipment with you.

Depends on your lifestyle, you can easily have a set at home and another at work. Insulin pumps reduce that problem too.

iop wrote:Seriously, if you invent an insulin pill, you are rich.

Certainly, however that will only be a first step.

ArgonV wrote:Are you sure? Don't they have does pen-like syringes that can be set to inject the needed dose? That's what the device of a former classmate of mine looked like anyway. When she showed me how to do it, in case of hyperglycaemia, she told me to just prick one end in her and press the other end. She might've had something out of the ordinary though.

Unless it is something I never heard of, she was probably doing it wrong. And, anyway, these pens still hurt and have potentially dangerous long term consequencies.

Hyperglycaemia can require an amount of insulin varying from a few units to tens of units. There are a number of injection sites but in case of emergency that is not a real problem. However, if she can't do it herself, she should be sent to the hospital ASAP.

ArgonV wrote:Also, isn't the timing real easy to figure out? The same girl had to have breakfast, lunch and dinner at approximately the same time every day (she had a leeway of about half an hour), so she didn't have any problems with her blood sugar.

It is hard to tell without knowing what she used, but regular schedules are generally a good idea.

sgt york wrote:
ArgonV wrote:And if you really want to get rich, invent a subdermal insulin-pump

Rich, sued, something like that. Money will change hands.

I think he was talking about artificial pancreas.
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Re: Accidentally ingesting insulin

Postby qetzal » Sat Jun 06, 2009 12:51 am UTC

Terebrant wrote:It depends on the spike, natural spikes are still quite different from those used in diabetes so the comparison isn't easy. I looked at the study linked by qetzal and it looks like there is a difference from what I know about how type 1 diabetics reacts (they would have had a lower glycemia).

quetzal, there were tests to make the patient absorb it in a dissociated form, their results were not that great either.


I'm not quite sure what you mean there. The study I linked looked at insulin lispro and insulin aspart. Both are so-called rapid acting insulins. They are more rapid than regular insulin because they've been engineered to dissociate from hexamer to monomer more easily, which speeds their absorption from the site of injection.

Also, I picked that study because it looked at healthy, non-diabetic subjects, it used a low dose of insulin (though still ~2-3 fold higher than the OP asked about), and it didn't dose the subjects with glucose. In other words, it was a controlled test of pretty much what the OP asked for - the effects of low insulin doses on healthy subjects. In that study, even with a mean dose of ~ 3.5 U (assuming 70 kg subjects), the observed hypoglycemia was fairly mild on average. Hence my conclusion that a dose of 1-2 U would probably not have very large effects. (Assuming it's injected; if it was ingested, there would be no effects at all.)
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Re: Accidentally ingesting insulin

Postby Wombat2k » Sat Jun 06, 2009 2:04 am UTC

Type one diabetic here. As has been said injecting 1 or two units would not be not so bad. It would be similar to drinking a few cans of diet red bull or taking a b6 pill ( I often use this to drop my sugar levels by a small amount without the pain of an injection). It would take massive amounts of insulin injections to hurt a normal person. As for ingesting there are pills that bind to sugar and prevent it entering your blood. An overdose of these pills would just make a normal person hungry.

It`s really hard to be badly hurt from a hypo (low). To start with I become hungry,. Then I get a mild aphasia, sweat and shake. ( this lasts for hours..I carry sugar with me at all times so when I notice I can just eat sugary food.). After that ( hit low sugar when asleep for example) I`m really sleepy, exausted. At that point either adrenaline kicks ( insulin shock...maybe ok for therapy ...but not good when you are shopping) or I go straight back to sleep. At some point either I eat or my body starts breaking down fat or muscle to produce more energy. It doesn`t feel nice. But not gonna die.
Insulin is normally injected subdermal ( below the skin) rather than directly into the blood. It`s possible to accidently inject near a blood vessel and have the insulin act faster than normal.

The worst thing that can happen is hyper. Too high sugar. A slightly high sugar level results in blindness and circulation problems. At worst you become dehydrated and there is celluar breakdown, resulting in a coma and death.

So being injected with a few units of insulin is not as bad as drinking a can of root beer. Injecting into a vein with a large dose will either give an adrenaline rush or make you asleep.
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Re: Accidentally ingesting insulin

Postby Terebrant » Sat Jun 06, 2009 9:17 am UTC

qetzal wrote:
Terebrant wrote:It depends on the spike, natural spikes are still quite different from those used in diabetes so the comparison isn't easy. I looked at the study linked by qetzal and it looks like there is a difference from what I know about how type 1 diabetics reacts (they would have had a lower glycemia).

quetzal, there were tests to make the patient absorb it in a dissociated form, their results were not that great either.


I'm not quite sure what you mean there. The study I linked looked at insulin lispro and insulin aspart. Both are so-called rapid acting insulins. They are more rapid than regular insulin because they've been engineered to dissociate from hexamer to monomer more easily, which speeds their absorption from the site of injection.

Also, I picked that study because it looked at healthy, non-diabetic subjects, it used a low dose of insulin (though still ~2-3 fold higher than the OP asked about), and it didn't dose the subjects with glucose. In other words, it was a controlled test of pretty much what the OP asked for - the effects of low insulin doses on healthy subjects. In that study, even with a mean dose of ~ 3.5 U (assuming 70 kg subjects), the observed hypoglycemia was fairly mild on average. Hence my conclusion that a dose of 1-2 U would probably not have very large effects. (Assuming it's injected; if it was ingested, there would be no effects at all.)

You quoted two things so I am not sure what you are precisely talking about. I am not sure I understand what you mean by "subjects with glucose" (diabetics ?). I don't have a problem with the study but from what I know type 1 diabetics would not have reacted in the exact same way, as there were discussion about diabetic subjects I thought I would add to the discussion.

When I wrote dissociated form for insulin pills, I meant the A and B chains of the monomere were separated.

For the different spikes, the classical bolus is not physiological but there are some development with insulin pumps to deliver insulin in a better fashion (square wave bolus for example is such an attempt).
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Re: Accidentally ingesting insulin

Postby qetzal » Sat Jun 06, 2009 2:00 pm UTC

Re "subjects with glucose"

One common technique for testing insulin in a clinical study is to give the subject insulin, then give them enough glucose to keep their blood sugar levels constant. That's called a "glucose clamp" or "euglycemic clamp." Obviously, when you do that, there won't be any possibility of hypoglycemia, so such studies wouldn't be relevant to the OP's question. So, I picked a study that didn't give the subjects glucose.

Re dissociation - I thought you meant something else. In concentrated form, insulin forms into hexamers. After it's injected, it has to dissociate to monomers before it will be efficiently absorbed from the site of injection and distributed throughout the body. (Each monomer still consists of an A and a B chain, though.) The versions of insulin used in that study had been slightly modified compared to regular human insulin, so they would dissociate from the hexamer form more easily.
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Re: Accidentally ingesting insulin

Postby adain21 » Tue Jul 14, 2009 6:09 am UTC

Hello all,

I'm a new user here and am worried about the possibility of insulin overdoses. I, fortunately, am not a sufferer of the condition but my mother is, so please excuse my lack of knowledge (although I am aware of the consequences of overdosing). My biggest fear is the fact that she lives alone and can be forgetful so may take a double dose by accident so I guess what I really need to know is how much is too much and is there anything I can do to help prevent this?
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Re: Accidentally ingesting insulin

Postby qetzal » Tue Jul 14, 2009 11:03 pm UTC

adain21,

I applaud your concern for your mother, but I don't think you should be trying to make decisions based on information you get on an internet forum.

I recommend you discuss your concerns with your mother, and ask if you can accompany her on her next doctor's visit. Then you can pose your questions to her doctor. He knows your mother's medical situation, and can give you the best advice.

Of course, I'm assuming your mother agrees to let her doctor discuss this with you. Otherwise, the doctor isn't legally allowed to disclose anything personal about your mother's medical condition, even to immediate relatives. (At least, that's the case in the US.) Even so, the doctor could still offer you general advice on what to do, so long as it doesn't involve specifics of your mother's condition.

Good luck!
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