Octreotide: an antidote for sulfonylurea-induced hypoglycemia.
OBJECTIVE
Sulfonylurea agents are widely used as therapy for hyperglycemia in type 2 diabetes mellitus. In overdose, these agents can produce sustained and profound hypoglycemia that is refractory to treatment with dextrose alone. Our objective was to determine whether treatment with octreotide decreases glucose requirements and the number of hypoglycemic episodes in patients with sulfonylurea-induced hypoglycemia.


METHODS
We retrospectively reviewed the charts of patients treated with octreotide for sulfonylurea-induced hypoglycemia from 1995 through 1998. The study took place in a large urban teaching hospital in the United States. We measured the number of episodes of hypoglycemia reported and the amount of dextrose used before and after treatment with octreotide. Using a failure time analysis, we compared the risk of hypoglycemia before and after octreotide administration.


RESULTS
The age range of the 9 patients was 20 to 65 years. Six patients ingested glyburide and 3 ingested glipizide. The number of hypoglycemic events recorded per patient before octreotide (mean 3.2) was greater than the number of hypoglycemic events recorded per patient after octreotide (mean 0.2, P =.008). Similarly, the number of ampules of 50% dextrose administered per patient before octreotide (mean 2.9) was greater than the number of ampules administered per patient after octreotide (0.2, P =.004). The risk of recurrent hypoglycemia before octreotide treatment was 27 times the risk of the group after octreotide treatment (P <.001). Stabilization of blood glucose concentration and cessation of rebound hypoglycemia occurred immediately after the administration of octreotide in all 9 patients.


CONCLUSIONS
Octreotide appears to be safe and effective in preventing rebound hypoglycemia after sulfonylurea ingestion. Octreotide in combination with dextrose should be considered for first-line therapy in the treatment of sulfonylurea-induced hypoglycemia.
From the Department of Emergency Medicine, University of New Mexico,(*) and the New Mexico Poison and Drug Information Center,(‡) Albuquerque, NM.
Steven A
SA
McLaughlin
From the Department of Emergency Medicine, University of New Mexico,(*) and the New Mexico Poison and Drug Information Center,(‡) Albuquerque, NM.
Cameron S
CS
Crandall
From the Department of Emergency Medicine, University of New Mexico,(*) and the New Mexico Poison and Drug Information Center,(‡) Albuquerque, NM.
Patrick E
PE
McKinney
D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage*; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D015282:Octreotide