Octreotide for relapsing sulfonylurea-induced hypoglycemia in a dialysis patient

Abstract

BACKGROUND: Hypoglycemia is the principle adverse effect of sulfonylurea, especially in patients with renal failure. Conventional treatment consists of hypertonic dextrose, sometimes combined with glucagon. However, paradoxically both agents can stimulate insulin secretion and induce rebound hypoglycemia. PATIENT: We present the case of a hemodialysis patient with relapsing gliclazide-induced hypoglycemia in the context of sepsis. RESULTS: Our patient failed to respond to regular infusions of hypertonic dextrose and oral carbohydrates. His hypoglycemia only resolved after a single dose of octreotide. The pathophysiology of recurrent sulfonylurea-induced hypoglycemia and the challenges of current therapies are discussed. The somatostatin analogue octreotide inhibits insulin release and has been proposed as an antidote for sulfonylurea overdose. CONCLUSIONS: We propose that octreotide has a clinical role in the treatment of patients with renal failure and sulfonylurea-induced hypoglycemia.