Daily bolus of LR: Hypoglycemia

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February 7, 2011 by dailybolusoflr

Hypoglycemia related to oral diabetic agents is a known phenomenon.
 
It is important to note that oral agents fall mainly into two broad classes
1.       Oral hypoglycemic (or agents that increase insulin secretion and thus lower blood glucose)
2.       Oral anti-hyper-glycemics (or agents that typically increase sensitivity to insulin and do not typically cause hypoglycemia)
 
Typical agents in the oral hypoglycemic class are: sulfonyureas (glipizide, glyburide etc) and secretagogues (repaglinide, nateglinide), while commonly known anti-hyper-glycemics are the biguanides (metformin) and the glitzones (rosiglitazone, pioglitazone).
 
Oral hypoglycemics are much more likely to cause hypoglycemia (hence the name) and as such, intentional overdoses or patients with repeated episodes of hypoglycemic (despite adequate substrate. .like a meal) should be observed for a length of time.  Some sources argue 6 hours for non-intentional overdoses, but most agree that in the setting of an intentional overdose, these patients should be watched for atleast 24 hours.
 
Patients should be treated with IV glucose until resumption of normal mental status. After this, the best cource of action is to feed the patient.  Often, this simple act is overlooked.
 
Octreotide inhibits insulin secretion and is a useful adjunct in treating sulfonyurea induced hypoglycemia.   The dose is 50mcg SQ every 6 hours for 24 hours.  Recommendations are in place that also state patients should be watched for 24 hours after octreotide is stopped.
 
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions

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