Octreotide for Sulfonylurea Induced Hypoglycemia

·         Sulfonylureas are a commonly used medication for diabetes that acts by stimulating insulin release from the beta cells of the pancreas

·         Patients with hypoglcyemia are often urgently treated with dextrose IV, which although temporizing and indicated in patients who are unable to eat, can result in acute hyperglycemia which can stimulate further insulin release from the pancrease which in turn can lead to recurrent hypoglycemia (a vicious cycle. .)

·         Octreotide can be used as a supplemental treatment in patients with recurrent hypoglycemia, related to both overdose as well as potentiation of drug effect related to impared metabolism or excretion of the drug

Octreotide

·         Is a synthetic somatostatin analogue that binds to receptors on the beta cell and prevents influx of calcium which is required for insulin secretion

·         Can be administered IV or SC

·         Has its peak effect in about 30 minutes; duration of action of about 6-12 hours SC

·         Is given at a dose in adults of 50-100mcg every 6-12 hours, preferred SC.  IV dose duration of action is 4-6 hours

·         Has been studied and appears to show benefit in decreasing the frequency of recurrent hypoglycemia in patients who are given octreotide

Ref: J. Med Toxicol. 2010. 6:199-206 and Ann Emerg Med. 2008. 51(4): 400-406