Use of Octreotide to Treat Prolonged Sulfonylurea-induced Hypoglycemia in a Patient with Chronic Renal Failure

Nzerue, Chike; Thomas, Jerry D.; Volcy, Judith; Edeki, Timi

doi:10.1177/039139880302600113

Cited by 16 publications

(4 citation statements)

References 19 publications

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“…Sulfonylureas have been reported to cause hypoglycemia, increase in body weight, gastrointestinal (GI) disturbance, and headache to the user [19]. Besides, metformin could cause abdominal pain, diarrhea, nausea, and lactic acidosis to the diabetic patient [20]. In other diabetic drug that causes adverse side effects is thiazolidinediones as it causes hepatotoxicity after long-time usage [21].…”

Section: Introductionmentioning

confidence: 99%

Antidiabetic and Hypolipidemic Activities ofCurculigo latifoliaFruit:Root Extract in High Fat Fed Diet and Low Dose STZ Induced Diabetic Rats

Ishak

Ismail

Hamid

et al. 2013

Evidence-Based Complementary and Alternative Medicine

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Curculigo latifolia fruit is used as alternative sweetener while root is used as alternative treatment for diuretic and urinary problems. The antidiabetic and hypolipidemic activities of C. latifolia fruit:root aqueous extract in high fat diet (HFD) and 40 mg streptozotocin (STZ) induced diabetic rats through expression of genes involved in glucose and lipid metabolisms were investigated. Diabetic rats were treated with C. latifolia fruit:root extract for 4 weeks. Plasma glucose, insulin, adiponectin, lipid profiles, alanine aminotransferase (ALT), gamma glutamyltransferase (GGT), urea, and creatinine levels were measured before and after treatments. Regulations of selected genes involved in glucose and lipid metabolisms were determined. Results showed the significant (P < 0.05) increase in body weight, high density lipoprotein (HDL), insulin, and adiponectin levels and decreased glucose, total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL), urea, creatinine, ALT, and GGT levels in diabetic rats after 4 weeks treatment. Furthermore, C. latifolia fruit:root extract significantly increased the expression of IRS-1, IGF-1, GLUT4, PPARα, PPARγ, AdipoR1, AdipoR2, leptin, LPL, and lipase genes in adipose and muscle tissues in diabetic rats. These results suggest that C. latifolia fruit:root extract exerts antidiabetic and hypolipidemic effects through altering regulation genes in glucose and lipid metabolisms in diabetic rats.

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Section: Introductionmentioning

confidence: 99%

Antidiabetic and Hypolipidemic Activities ofCurculigo latifoliaFruit:Root Extract in High Fat Fed Diet and Low Dose STZ Induced Diabetic Rats

Ishak

Ismail

Hamid

et al. 2013

Evidence-Based Complementary and Alternative Medicine

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“…More recently, octreotide has emerged as a viable therapeutic alternative. [5][6][7][8][9][10][11] Octreotide is a synthetic somatostatin analogue able to inhibit the release of a number of hormones, including insulin. After being injected subcutaneously, it acts within 20 minutes.…”

Section: Discussionmentioning

confidence: 99%

Octreotide for relapsing sulfonylurea‐induced hypoglycemia in a dialysis patient

Yavari

Ostermann

MacLean

et al. 2007

Dialysis & Transplantation

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With the predicted epidemic of type 2 diabetes mellitus and the clear link between glycemic control and longterm outcomes, the use of oral hypoglycemic agents is likely to increase. The major adverse effect of sulfonylurea agents is hypoglycemia, which traditionally is treated with hypertonic dextrose. Our case illustrates the challenges and pitfalls of the management of relapsing hypoglycemia in a hemodialysis patient on regular gliclazide. Case ReportA 47-year old hemodialysis patient with type 2 diabetes mellitus was admitted to the hospital because of vascular access problems. He usually took 80 mg of gliclazide once a day, with a capillary blood glucose measurement (BM) of 6-10 mmol/L. Other medications that he took included omeprazole, amlodipine, fluoxetine, ramipril, amitriptyline, atorvastatin, aspirin, and darbepoetin alfa.One week into his admission, the patient became septic and was started on empirical treatment with vancomycin for a presumed catheter-related infection. During the night, his BM gradually fell to 1.9 mmol/L despite regular snacks. In the morning he was confused, hypotensive, and sweating profusely. He was resuscitated with 50 mL of 50% dextrose given intravenously (IV), 1 mg of glucagon given subcutaneously (SC), and IV fluids.His condition improved temporarily. However, during the course of the day, he had 4 additional episodes of symptomatic hypoglycemia requiring intervention with boluses of 50% dextrose. A second dose of glucagon was given, mainly in an attempt to reduce the amount of IV dextrose necessary (Figure 1). A clear decrease in the response to hypertonic dextrose was noted, both in peak BM attained and in the time before a repeat bolus was needed. On the fifth occasion, his BM fell to 2.2 mmol/L, and he was given a single dose of 50 g of octreotide SC in addition to 50 mL of 50% dextrose IV and 100 mg of hydrocortisone IV. Within 20 minutes his BM was 8.6 mmol/L, and it remained above 5.5 mmol/L for the next 6 hours. Subsequent BMs ranged from 10 to 14 mmol/L.His serum cortisol level measured at 4 PM, prior to administration of hydrocortisone, was 501 nmol/L (9 AM reference range 120-500 nmol/L), with an insulin level of 1098 pmol/L (normal range 0-75 pmol/L). Blood cultures yielded methicillin-sensitive Staphylococcus aureus. His dialysis catheter was removed, and gliclazide was permanently discontinued. He had no further episodes of hypoglycemia and made a full recovery. DiscussionSulfonylureas act predominately by stimulating the release of preformed insulin from pancreatic ␤-cells. They also enhance insulin activity by reducing extrahepatic clearance of insulin. Sulfonylureas are hepatically metabolized and differ predominately in their duration of action and in the degree of renal excretion of the parent compound or active metabolite. In the UKPDS study, the incidence of major sulfonylurea-associated hypoglycemia was 1.0%-1.4%, compared with an incidence of 1.8% with insulin. 1 In general, this risk is increased in older patients; with renal impairment, liver disea...

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“…Patients have also been described with sulphonylurea induced HH who are refractory to treatment with boluses of dextrose but respond to octreotide. 189 Since the first reports, there have been numerous studies 190 – 217 describing treatment of sulphonylurea overdoses with octreotide. In virtually all the studies that reported the use of octreotide, there were no serious adverse effects.…”

Section: The Role Of Sst Analogues In Treatment Of Hhmentioning

confidence: 99%

Somatostatin analogues for the treatment of hyperinsulinaemic hypoglycaemia

Haris

Saraswathi

Hussain

2020

Therapeutic Advances in Endocrinology

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Hyperinsulinaemic hypoglycaemia (HH) is a biochemical finding of low blood glucose levels due to the dysregulation of insulin secretion from pancreatic β-cells. Under normal physiological conditions, glucose metabolism is coupled to β-cell insulin secretion so that blood glucose levels are maintained within the physiological range of 3.5–5.5 mmol/L. However, in HH this coupling of glucose metabolism to insulin secretion is perturbed so that insulin secretion becomes unregulated. HH typically occurs in the neonatal, infancy and childhood periods and can be due to many different causes. Adults can also present with HH but the causes in adults tend to be different. Somatostatin (SST) is a peptide hormone that is released by the delta cells (δ-cells) in the pancreas. It binds to G protein-coupled SST receptors to regulate a variety of location-specific and selective functions such as hormone inhibition, neurotransmission and cell proliferation. SST plays a potent role in the regulation of both insulin and glucagon secretion in response to changes in glucose levels by negative feedback mechanism. The half-life of SST is only 1–3 min due to quick degradation by peptidases in plasma and tissues. Thus, a direct continuous intravenous or subcutaneous infusion is required to achieve the therapeutic effect. These limitations prompted the discovery of SST analogues such as octreotide and lanreotide, which have longer half-lives and therefore can be administered as injections. SST analogues are used to treat different forms of HH in children and adults and therapeutic effect is achieved by suppressing insulin secretion from pancreatic β-cells by complex mechanisms. These treatments are associated with several side effects, especially in the newborn period, with necrotizing enterocolitis being the most serious side effect and hence SS analogues should be used with extreme caution in this age group.

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Use of Octreotide to Treat Prolonged Sulfonylurea-induced Hypoglycemia in a Patient with Chronic Renal Failure

Cited by 16 publications

References 19 publications

Antidiabetic and Hypolipidemic Activities ofCurculigo latifoliaFruit:Root Extract in High Fat Fed Diet and Low Dose STZ Induced Diabetic Rats

Antidiabetic and Hypolipidemic Activities ofCurculigo latifoliaFruit:Root Extract in High Fat Fed Diet and Low Dose STZ Induced Diabetic Rats

Octreotide for relapsing sulfonylurea‐induced hypoglycemia in a dialysis patient

Somatostatin analogues for the treatment of hyperinsulinaemic hypoglycaemia

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