Octreotide’s Role in the Management of Sulfonylurea-Induced Hypoglycemia

Abstract

The objective is to evaluate the evidence regarding octreotide's efficacy as a treatment for sulfonylurea-induced hypoglycemia. A search of PubMed for articles published from 1965 to 2008 using combinations of the terms octreotide, antidote, sulfonylurea, overdose, poisoning, and toxicity was performed. References from identified articles were reviewed for additional sources. Animal studies, case reports, case series, and randomized controlled trials were evaluated. An animal model of sulfonylurea overdose demonstrates that octreotide reduces the number of refractory sulfonylurea-induced hypoglycemic episodes. Published case reports describe the use of octreotide to prevent recurrent hypoglycemia after sulfonylurea overdose. A retrospective case series demonstrates that administration of octreotide decreases the need for supplemental dextrose boluses as well as hypoglycemic events. Two prospective, controlled trials determined that octreotide and supplemental dextrose increase blood glucose concentrations with fewer hypoglycemic events. Based on animal and human data, there is sufficient evidence to recommend the use of octreotide with supplemental dextrose for the treatment of sulfonylurea-induced hypoglycemia.

Severe hypoglycaemia among patients with type 2 diabetes requiring emergency hospital admission: The Hypoglycaemia In Portugal Observational Study–Emergency Room (HIPOS–ER)

“…In HIPOS‐ER, the secretagogue‐based therapy represented the largest group (50.5%) of hospitalized patients, and was the strongest predictor for hospitalization (OR 5.71). These results were to be expected because hypoglycaemia triggered by secretagogues can be long‐lasting, more severe, and recurrent . The present results are consistent with recent data from other studies, including those on secretagogues …”

“…These results were to be expected because hypoglycaemia triggered by secretagogues can be long-lasting, more severe, and recurrent. 13,20,24,32,33 The present results are consistent with recent data from other studies, including those on secretagogues. 12,13,15,24,29,34 Severe hypoglycaemia is a serious adverse event associated with consequences such as a higher risk of accidents and death.…”

Octreotide for hypoglycemia caused by sulfonylurea and DPP-4 inhibitor

“…In sulfonylurea-induced hypoglycemia, there is even a possibility that administered dextrose stimulates insulin secretion and prolongs hyperinsulinemia, resulting in recurrent hypoglycemia [1,2]. When patients are treated with incretin-based therapy, insulin secretion by the dextrose could be further enhanced, because of the glucose-dependent nature of incretin actions.…”

Confirmed Glyburide Poisoning from Ingestion of “Street Valium”

“…Glucagon relies on glycogen stores and has a short pharmacologic duration of glucagon. In addition to other animal and human data, one small prospective, doubleblind, placebo-controlled study found that one-time administration of octreotide in adult sulfonylurea poisonings increased serum glucose values for the first 8 h after administration and decreased the number of recurrent hypoglycemic episodes (14,15). Our regional poison control center routinely recommends octreotide 50-100 mg s.c. or i.v.…”