Insulin to the rescue: a review of recent reports on insulin treatment in emergencies and poisonings

Insulin, produced by pancreatic β-cells, is a critical anabolic hormone that plays a pivotal role in the regulation of carbohydrate metabolism. Dysregulation of insulin secretion can pose significant threats to health and life, underscoring the importance of its discovery. The introduction of insulin as a therapeutic agent revolutionized diabetes management. Currently, human insulin and its analogs, manufactured through advanced genetic engineering techniques, are widely used. Despite more than a century of clinical use, efforts to improve insulin formulations continue, aiming to enhance patient comfort and reduce the frequency of injections. Insulin is also employed in the management of acute conditions, such as diabetic ketoacidosis and hyperglycemic hyperosmolar state, where intravenous administration is used to lower blood glucose levels effectively. Additionally, insulin is effective in the treatment of hyperkalemia and in cases of poisoning with calcium channel blockers and β-receptor antagonists. In these scenarios, insulin has the highest therapeutic recommendation class. High-dose insulin euglycemic therapy (HIET) is implemented using doses of approximately 1 IU/kg body weight, regardless of patient age, with careful maintenance of euglycemia. HIET is also considered in cases of poisoning with metal phosphides and refractory shock. Positive outcomes have been reported in the literature for patients treated with high-dose insulin for caffeine poisoning and venlafaxine toxicity. These isolated reports highlight the need for further research and development of insulin therapy in acute medical conditions, potentially expanding its applications beyond traditional indications.