Untitled

Abstract

The major potential adverse effect of use of sulfonylurea agents (SUAs) is a hyperinsulinaemic state that causes hypoglycaemia. It may be observed during chronic therapeutic dosing, even with very low doses of a SUA, and especially in older patients. It may also result from accidental or intentional poisoning in both diabetic and nondiabetic patients. The traditional approach to SUA-induced hypoglycaemia includes administration of glucose, and glucagon or diazoxide in those who remain hypoglycaemic despite repeated or continuous glucose supplementation. However, these antidotal approaches are associated with several shortcomings, including further exacerbation of insulin release by glucose and glucagon, leading only to a temporary beneficial effect and later relapse into hypoglycaemia, as well as the adverse effects of both glucagon and diazoxide. Octreotide inhibits the secretion of several neuropeptides, including insulin, and has successfully been used to control life-threatening hypoglycaemia caused by insulinoma or persistent hyperinsulinaemic hypoglycaemia of infancy. Therefore, this agent should in theory also be useful to decrease glucose requirements and the number of hypoglycaemic episodes in patients with SUA-induced hypoglycaemia. This has apparently been confirmed by experimental data, one retrospective study based on chart review, and several anecdotal case reports. There is thus a need for further prospective studies, which should be adequately powered, randomized and controlled, to confirm the probable beneficial effect of octreotide in this setting. IntroductionAlthough the number of oral medications available to treat diabetes mellitus has increased, sulfonylurea agents (SUAs) remain a mainstay of therapy for hyperglycaemia in type 2 diabetes. The major potential adverse effect of use of SUA is a hyperinsulinaemic state that causes hypoglycaemia. It may be observed during chronic therapeutic dosing, even with very low doses of a SUA, and especially in older patients. It may also result from accidental or intentional poisoning in both diabetic and nondiabetic patients [1].The traditional approach to SUA-induced hypoglycaemia includes the administration of glucose, and glucagon or diazoxide in those who remain hypoglycaemic despite repeated or continuous glucose supplementation [2,3]. However, these antidotal approaches are associated with several shortcomings, including further exacerbation of insulin release by glucose and glucagon, leading only to a temporary beneficial effect and later relapse into hypoglycaemia [3], as well as the adverse effects of both glucagon and diazoxide [2,4]. Other measures that have been proposed include corticosteroids and urinary alkalinization to enhance urinary elimination of the SUA (e.g. chlorpropamide) [5], but their usefulness has not clearly been established.Octreotide inhibits the secretion of several neuropeptides, including insulin, and has been successfully used to control life-threatening hypoglycaemia caused by insulinoma [6,7] or persistent h...

Successful Use of Octreotide Therapy for Refractory Levofloxacin-Induced Hypoglycemia: A Case Report and Literature Review

“…In this therapeutic approach, transient beneficial increases in serum glucose are offset by rebound hypoglycemia that can especially occur in patients taking medications affecting pancreatic KATP β -cell channels such as sulfonylureas. This is caused by the additional glucose further stimulating insulin release in patients with intact pancreatic function (e.g., nondiabetics or patient with type-2 noninsulin dependent diabetes) [33, 34]. Given the similarities in biological mechanism to sulfonylureas, it is reasonable to propose that this phenomenon of rebound hypoglycemia may occur with fluoroquinolones as well.…”

“…Octreotide is a potent and long-acting synthetic analog of the inhibitory peptide hormone somatostatin [33]. Voltage-gated calcium channels on the pancreatic β -cell membrane are coupled to G-protein somatostatin-2 receptors.…”

Hypoglycemia Revisited in the Acute Care Setting

“…Administration of glucose or glucagon in patients with sulphonylurea-induced hypoglycemia may be unsatisfied because these antidotal approaches are associated with further exacerbation of insulin release by glucose and glucagon, leading to only temporary beneficial effects and later RH. 82 , 83 Octreotide can be safely and effectively used in treatment of sulphonylurea-induced hypoglycemia in patients with congestive heart failure and renal failure by adhering to dosing guidelines and close monitoring. 84 , 85 …”

Somatostatin analogues for the treatment of hyperinsulinaemic hypoglycaemia

“…Patients have also been described with sulphonylurea induced HH who are refractory to treatment with boluses of dextrose but respond to octreotide. 189 Since the first reports, there have been numerous studies 190 – 217 describing treatment of sulphonylurea overdoses with octreotide. In virtually all the studies that reported the use of octreotide, there were no serious adverse effects.…”