Use of octreotide acetate to prevent rebound hypoglycemia in sulphonyluria overdose

Date First Published:
September 24, 2002
Last Updated:
June 18, 2007
Report by:
Ziauddin Hassan, Registrar in Emergency Medicine (Newcastle General Hospital)
Search checked by:
Dr John Wright, Newcastle General Hospital
Three-Part Question:
In [patients with sulphonyluria overdose] does [octreotide acetate] prevent [rebound hypoglycemia]
Clinical Scenario:
56-year-old man known to have non-insulin dependent diabetes mellitus presents to the Emergency Department after taken an overdose of his own oral hypoglycaemic - Glipizide. The initial blood sugar was very low; therefore he was given a 50 ml bolus of 50% dextrose. The patient recovered but despite a continuous intravenous infusion of 10% dextrose, hypoglycemia recurred. You know that intra-venous dextrose stimulates insulin release, and that sulfhonylurea compounds have a long half-life. You wonder about the use of the somatostatin analogue octreotide, which causes marked suppression of serum immunoreactive insulin and C-peptide concentration, and whether it is safe and effective under such circumstances.
Search Strategy:
Medline 1950 to April 07 using Ovid interface
The Cochrane Library issue 2 2007
Search Details:
Medline:[ exp.hypoglycemia or rebound hypoglycaemia. mp] AND [exp. Hypoglycaemic agent/ or Sulfonylurea compounds/ or sulfonylurea overdose.mp or sulfonylurea poisoning.mp] AND [exp octreotide acetate or octreotide .mp] and LIMIT to human AND English.
The Cochrane Library: Exp hypoglycemia {MeSH}and exp sulfonylurea compounds {MeSH] and exp octreotide [MeSH].
Outcome:
No relevant papers found on Cochrane library. Altogether 14 papers were identified of only 2 were directly relevant to the question. These are summarised in the table below:
Relevant Paper(s):
Study Title Patient Group Study type (level of evidence) Outcomes Key results Study Weaknesses
Octreotide reverses hyperinsulinemia and prevents hypoglycemia induced by sulfonylurea overdoses. Boyle PJ, Justice K, Krentz AJ, Nagy RJ, Schade DS. 1993, New Mexico 8 healthy volunteers, age range 18-50 years given 1.45 mg/kg Glipizide
When glucose had dropped to 50 mg/dL then 50 ml 50% glucose was given followed by either variable dextrose infusion or octreotide. At 5h a second 50% glucose bolus was administered and the time to return to target glucose level was measured		 Experimental study on healthy volunteers Time to return to target glucose level of 85 mg/dl after second 50% glucose bolus 3 h vs 6.5h (p=0.001) Small number, experimental study
Not blinded, subject to bias
Octreotide: an antidote for sulfonylurea-induced hypoglycemia. McLaughlin SA, Crandall CS, McKinney PE. 1999, New Mexico 9 patients of whom 6 had taken a Glyburide OD and 3 a Glipizide OD.
Age range 20-65 yrs		 Observational Mean number of episodes of hypoglycemia before and after treatment with octreotide 3.2 vs 0.2 (p=0.008) Retrospective chart review design
Sample size small
Mean number of ampoules of 50% dextrose before and after treatment with octreotide 2.9 vs 0.2 (p=0.004)
Author Commentary:
There are very few reports and most of them are reviews, case reports and letters. Each of these studies has small numbers of patients. It is difficult to recruit a large series of patients in a single centre. A large multicentre study is needed.
Bottom Line:
Octreotide may be safe and effective in preventing rebound hypoglycaemia in sulphonlyurea overdose. Octreotide in combination with dextrose can be considered for first-line therapy in treatment of sulphonlyurea-induced hypoglycaemia
References:
  1. Boyle PJ, Justice K, Krentz AJ, Nagy RJ, Schade DS.. Octreotide reverses hyperinsulinemia and prevents hypoglycemia induced by sulfonylurea overdoses.
  2. McLaughlin SA, Crandall CS, McKinney PE.. Octreotide: an antidote for sulfonylurea-induced hypoglycemia.