Bench-to-bedside review: Antidotal treatment of sulfonylurea-induced hypoglycaemia with octreotide.
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.
Lheureux
Philippe E R
PE
Department of Emergency Medicine, Erasme University Hospital, Brussels, Belgium. plheureu@ulb.ac.be
Zahir
Soheil
S
Penaloza
Andrea
A
Gris
Mireille
M
D000328:Adult; D000368:Aged; D000818:Animals; D000931:Antidotes / Q000191:economics / Q000627:therapeutic use*; D001786:Blood Glucose / Q000187:drug effects; D002648:Child; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D062787:Drug Overdose; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D015282:Octreotide / Q000191:economics / Q000627:therapeutic use*; D013453:Sulfonylurea Compounds / Q000009:adverse effects*; D016896:Treatment Outcome
D000931:Antidotes; D001786:Blood Glucose; D005765:Gastrointestinal Agents; D013453:Sulfonylurea Compounds; D015282:Octreotide