Acute insulin-induced hypoglycemia in twin neonates

Abstract

Twin neonates with a history of exogenous insulin administration by a mother suffering from post-partum psychosis are reported. Twin 1 presented with lethargy, while twin 2 presented with apnea and bradycardia, requiring vigorous resuscitation. During their neonatal intensive care unit stay, both the babies developed multiple episodes of symptomatic refractory hypoglycemia with seizures and were managed with intravenous dextrose boluses and infusion, glucagon infusion, octreotide, diazoxide, and glucocorticoids. Although short-acting regular insulin (Actrapid, Novo Nordisk™) preparation was administered to the neonates, its effects were seen for a duration of 3–4 days, probably due to the depot effect. We highlight the importance of history taking and physical examination for early diagnosis and appropriate management.