Falsified semaglutide injections cause severe synthetic insulin intoxication, coma, and hypothermia in two non-diabetic patients.

The increasing popularity of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) like semaglutide for obesity and type 2 diabetes has led to a burgeoning off-label market. Strict reimbursement criteria often push individuals to unregulated sources, bypassing essential quality controls. This lack of oversight creates a significant patient safety risk, as the authenticity and composition of medications obtained outside the legitimate healthcare system cannot be guaranteed, potentially leading to severe adverse events from adulterated or falsified products.

This report details two clinical cases involving patients without pre-existing diabetes or obesity who self-administered semaglutide obtained illicitly. Both individuals presented to emergency care in a comatose state, exhibiting severe hypoglycemia, hypokalemia, and hypothermia. Clinical investigation, including toxicological analysis, confirmed that their symptoms were caused by intoxication with synthetic insulin, not by the intended GLP-1 RA mechanism. The patients required intensive medical management to stabilize their glucose levels and other vital signs.

Both patients, after injecting illegally sourced semaglutide, presented in a coma with severe hypoglycemia, hypokalemia, and hypothermia. Crucially, investigations revealed the presence of synthetic insulin as the causative agent for their critical condition, not the GLP-1R agonism of semaglutide itself. Legitimate semaglutide monotherapy is not associated with significant hypoglycemia in healthy individuals. The severity of the insulin intoxication necessitated prolonged medical intervention:

Patients required continuous glucose infusion for up to two days to maintain euglycemia, highlighting the profound and sustained metabolic disruption caused by the falsified product.
This prolonged need for glucose support underscores the potent and dangerous nature of the synthetic insulin contaminant. Timely notification to health authorities was deemed essential to prevent further distribution of these hazardous, falsified drugs.