Review of octreotide as an antidote for sulfonylurea-induced hypoglycemia

April 9, 2010, 10:36 am

★★★★☆

Octreotide’s Role in the Management of Sulfonylurea-Induced Hypoglycemia.  Dougherty PP, Klein-Schwartz W.  J Med Toxicol [published online 30 March 2010]

Abstract

Sulfonylureas help control hyperglycemia in type II diabetics by enhancing insulin release from pancreatic β cells.  A frequent source of clinical frustration in treating sulfonylurea toxicity is recurrent episodes of hypoglycemia, caused by the following vicious circle: intravenous dextrose -> hyperglycemia -> increased insulin released from the sulfonylurea-primed pancreas -> hypoglycemia -> additional intravenous dextrose -> etc etc.

Octreotide — a long-acting somatostatin analog — interrupts this cycle by blocking calcium entry into the β cells, a necessary step leading to insulin release.  This article, from the Maryland Poison Center, reviews evidence for the use of octreotide in this setting published in the medical literature from 1965 to 2008.

When used to treat sulfonylurea-induced hypoglycemia, octreotide is usually given subcutaneously.  The authors conclude that “there is sufficient evidence to recommend the use of octreotide with supplemental dextrose for the treatment of sulfonylurea-induced hypoglycemia in patients for whom supplemental dextrose alone is insufficient.” They suggest that doses of 50-100 mcg every 8 hours will be effective in most patients.

For another excellent review of octreotide as an antidote, read James R. Roberts’ recent  column in Emergency Medicine News.

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