Octreotide reverses hyperinsulinemia and prevents hypoglycemia induced by sulfonylurea overdoses.

Abstract

Emergency therapy of sulfonylurea overdoses with glucose is often unsatisfactory because glucose stimulates insulin release and initiates a need for escalating quantities of hypertonic glucose to maintain normoglycemia. We tested the hypothesis that octreotide, an analog of somatostatin, would reverse hyperinsulinemia induced by a sulfonylurea overdose. Eight normal subjects received glipizide (1.45 mg/kg) on three occasions. Within 3 h, all subjects became hypoglycemic (< 50 mg/dL) and were initially treated with 50% dextrose followed by 1) dextrose infusion, 2) octreotide (30 ng/kg.min, iv), or 3) diazoxide (300 mg, iv, every 4 h). Euglycemia (85 mg/dL) was maintained with supplementary dextrose in treatment limbs 2 and 3. Insulin concentrations were 4-5 times greater with dextrose alone or in combination with diazoxide than with octreotide (P < 0.01). Dextrose requirements during diazoxide or dextrose alone were not different, but were both greater than those during octreotide treatment (P < 0.0001). All therapies were stopped at 13 h. Glucose levels remained above 3.6 mmol/L (65 mg/dL) in six of eight subjects receiving octreotide for the remaining 4 h. Glucose fell to below 3.6 mmol/L within 1.5 h of stopping either dextrose or diazoxide in each subject. Overall, octreotide reduced and in four of eight subjects entirely eliminated the need for exogenous glucose after a large overdose of glipizide. We conclude that octreotide is safe and effective and should be strongly considered as a logical therapeutic alternative for this metabolic emergency.

Recalcitrant hypoglycemia resolved with 2.5% dextrose containing replacement fluid during hemodiafiltration

“…10 Of note, octreotide may be an effective agent to ameliorate sulfonylurea-induced hypoglycemia. 11,12 In our case, incorporating a custom-made replacement fluid solution with a final sodium concentration of 150 mEq/L and containing 2.5% dextrose provided the required large net glucose influx without producing volume overload or worsening hyponatremia. Whether CVVHDF may have contributed to the removal of glipizide and hastened the recovery from hypoglycemia, is little studied and unknown at the present time; however, the high protein-bound nature of glipizide (498%) 13 makes this relatively less likely.…”

Octreotide for relapsing sulfonylurea‐induced hypoglycemia in a dialysis patient

“…Similarly, in a study of glipizide overdose in 8 volunteers, insulin concentrations were 4-5 times higher in those treated with dextrose or dextrose-diazoxide than in those treated with octreotide. 10 Significantly less dextrose was required in the octreotide group (p Ͻ .001).…”

“…More recently, octreotide has emerged as a viable therapeutic alternative. [5][6][7][8][9][10][11] Octreotide is a synthetic somatostatin analogue able to inhibit the release of a number of hormones, including insulin. After being injected subcutaneously, it acts within 20 minutes.…”

CHAMACON: exposiciones potencialmente letales en pediatría

“…Para contrarrestar este efecto puede emplearse octreótido a dosis de 1 a 2 μcg/kg subcutáneo cada 6 a 12 horas, administrar desde el inicio una infusión continua de glucosa suficiente para mantener la glucemia entre 100 y 150 mg/dL, o ambas cosas. 21 Para tal efecto no existe una dosis establecida debido a que la respuesta depende básicamente de la dosis de sulfonilurea administrada y las reservas previas de glucosa; sin embargo, los autores sugerimos iniciar con aportes de glucosa-kgminuto de 6 a 8 g para lactantes y de 4 a 6 g para niños mayores, reajustando el aporte de acuerdo con las necesidades del paciente.…”