[Insulin intoxications caused by falsified semaglutide].

BACKGROUND: Treatment with glucagon-like peptide-1 receptor agonists such as semaglutide is generally subject to strict reimbursement criteria. This leads to a growing off-label market outside of the regular healthcare system without strict quality controls, which may jeopardize patient safety. CLINICAL CONTEXT: Two cases are reported of patients without diabetes or obesity, who had injected semaglutide subcutaneously that was obtained without a prescription. Both presented in a coma with severe hypoglycemia, hypokalemia and hypothermia, which was caused by an intoxication with synthetic insulin. Monotherapy with semaglutide is not associated with significant hypoglycemia in healthy individuals. Up to two days of continuous glucose infusion was required to keep patients euglykemic. CONCLUSION: The use of illegally obtained semaglutide may lead to life-threatening intoxications, due to insufficient safety precautions for the provided medication. Timely notification of cases to the national health regulatory authority is essential to mitigate further distribution of falsified drugs.