Octreotide therapy for recurrent refractory hypoglycemia due to sulfonylurea in diabetes-related kidney failure.
OBJECTIVE
To describe a patient with kidney insufficiency from diabetes treated with glyburide, who presented with prolonged and recurrent hypoglycemia unresponsive to large intravenous doses of glucose, which was treated successfully with intravenously administered octreotide, and to review the therapeutic options for hypoglycemia.


METHODS
We present a case report of a 66-year-old man with diabetes causing chronic kidney disease, who was treated with orally administered glyburide, 7.5 mg twice a day. He initially presented to another hospital because of hypoglycemia and was treated with intravenously administered glucose and discharged. The next day, his family brought him to our emergency department because of recurring low blood glucose levels and symptoms of sweating, fever, and nightmares. Laboratory tests revealed a blood glucose level of 33 mg/dL and a creatinine concentration of 6.2 mg/dL.


RESULTS
The patient was treated with a 5% dextrose and, subsequently, a 10% dextrose infusion without any sustained improvement. The blood glucose level remained low despite the additional administration of 3 ampules of 50% dextrose in water. The patient was given a bolus of octreotide (50 mug subcutaneously) 14 hours after his second presentation. He received another 50-mug dose of octreotide 6 hours later. After this bolus, the hypoglycemia resolved, and he no longer required intravenous administration of glucose to maintain euglycemia.


CONCLUSIONS
Patients with diabetes and kidney disease frequently have persistent and difficult-to-treat hypoglycemia, unresponsive to conventional therapy. Octreotide is an effective and safe treatment for patients with refractory hypoglycemia attributable to sulfonylureas.
Gonzalez
Rita R
RR
New York University School of Medicine, New York 10016, USA.
Zweig
Susan
S
Rao
Jyoti
J
Block
Romy
R
Greene
Loren W
LW
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D005905:Glyburide / Q000009:adverse effects*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008297:Male; D015282:Octreotide / Q000008:administration & dosage*; D012008:Recurrence; D051437:Renal Insufficiency / Q000209:etiology
D005765:Gastrointestinal Agents; D007004:Hypoglycemic Agents; D015282:Octreotide; D005905:Glyburide