Extended-Release Glipizide Overdose Presenting with Delayed Hypoglycemia and Treated with Subcutaneous Octreotide

Abstract

The onset of symptomatic hypoglycemia in children with ingestions of second-generation sulfonylureas has never been documented to be later than 21 hours post-ingestion. We report a case with the longest known interval, 45 hours, between ingestion of a sulfonylurea and the onset of hypoglycemia requiring medical intervention. The hypoglycemia was severe and required multiple dextrose boluses in addition to continuous dextrose infusion for 36 hours. This patient was also treated with multiple doses of subcutaneous octreotide because of persistent hypoglycemia despite the above management. This case represents the first report of subcutaneous octreotide used as a treatment for pediatric hypoglycemia secondary to sulfonylurea exposure.

Unwitnessed sulphonylurea poisoning in a healthy toddler

“…Although most patients develop hypoglycaemia within 8 h of sulphonylurea ingestion [4,27], delayed hypoglycaemia can occur up to 11 h later [28] or even longer (45 h) in the case of extended-release glipizide [19]. Supratherapeutic doses of sulphonylurea may further prolong the duration of effect, although the time of onset remains the same [8].…”

“…Several authors have recently reported the successful use of octreotide in children for the treatment of sulphonylureainduced hypoglycaemia [5,19,25,26]. As a synthetic analogue of the endogenous hormone somatostatin, octreotide is favoured as an antidote adjunct in dextrose-refractory sulphonylurea-induced hypoglycaemia because it inhibits insulin secretion [3] and prevents rebound hypoglycaemia.…”

“…As a synthetic analogue of the endogenous hormone somatostatin, octreotide is favoured as an antidote adjunct in dextrose-refractory sulphonylurea-induced hypoglycaemia because it inhibits insulin secretion [3] and prevents rebound hypoglycaemia. Although the use of octreotide may obviate the need for central venous hypertonic dextrose therapy in witnessed or suspected sulphonylurea-induced hypoglycaemia [19,25], the same may not be true in unwitnessed sulphonylurea poisoning presenting with severe neuroglycopaenia. Uncertainties about the cause of hypoglycaemia and the dose of sulphonylurea ingested mean that the course and outcome is likely to be highly variable.…”

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“…[1,2] Diabetes mellitus is a group of metabolic diseases characterized by defects in insulin utilization, either from autoimmune destruction of insulin producing cells (Type I) or insulin resistance (Type II). [3] The prevalence of Type II diabetes is rising dramatically worldwide. [4] There are more than 171 million people with diabetes, and in the US, Canada, and Europe, over 80% of diabetes cases are Type II.…”

“…[5] It was the 6 th leading cause of death due to the many complications associated with this disease, such as pulmonary hypertension and ischemia. [3,6] Gliclazide is a second generation sulfonylurea that can acutely lower the blood glucose level in humans by stimulating the release of insulin from the pancreas and is typically prescribed to treat Type II diabetes. Its half-life is relatively short (25 h) which necessitates its administration in 2 or 3 doses of 2.5-10 mg/day.…”