Maria Fleseriu

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. CONCLUSION 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.