Successful treatment of sulfonylurea-induced prolonged hypoglycemia with use of octreotide.
OBJECTIVE
To report the successful use of octreotide in the management of prolonged hypoglycemia attributable to therapeutic doses of sulfonylureas.


METHODS
We present a case series of 6 patients with sulfonylurea-induced hypoglycemia, along with pertinent serial laboratory data and review of the course of management.


RESULTS
Most of our 6 study patients had diabetes mellitus, which had been managed with sulfonylurea therapy. In the context of renal failure or heart failure (or both), severe, prolonged hypoglycemia developed. Intermittent intravenous administration of 50% dextrose did not result in a sustained and adequate response. Continuous intravenous administration of dextrose-containing solutions was contraindicated because of fluid overload as a result of congestive heart failure or renal failure. Administration of octreotide, 50 microg subcutaneously every 8 hours, resulted in a prompt and sustained resolution of the hypoglycemia. In 3 of the 6 study subjects, measurements of insulin and C-peptide levels both before and after treatment confirmed the efficacy of the octreotide therapy.


CONCLUSIONS
Our cases demonstrate that octreotide proves to be an effective treatment intervention for prolonged hypoglycemia caused by therapeutic doses of sulfonylureas. This is the first major report of the safe and effective use of octreotide in the management of sulfonylurea-induced hypoglycemia outside the emergency department setting.
Fleseriu
Maria
M
Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Skugor
Mario
M
Chinnappa
Priya
P
Siraj
Elias S
ES
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D012074:Remission Induction; D013453:Sulfonylurea Compounds / Q000009:adverse effects*
D001786:Blood Glucose; D013453:Sulfonylurea Compounds; D015282:Octreotide