Sulphonylurea-associated hypoglycemia - Introduction:

Sulfonylureas cause hypoglycemia by stimulating ß-cells to secrete insulin in the presence of glucose. Thus, intravenous dextrose can prolong the hypoglycaemia.

Suspect this diagnosis if hypoglycemia is prolonged or not responding to dextrose treatment.

Sulfonylurea-induced hypoglycemia is more likely in patients with:

• Renal impairment
• Hepatic impairment
• Sepsis
• Insulin co-administration
• Age >65 years old.
  
  • Do not restart sulfonylurea medications, and avoid their use in high risk patients

Management

Treatment is Octreotide, 50 mg given subcutaneously or intravenously STAT

• The dose can be repeated after 2-4 hours
• An infusion may sometimes be required.

Glucagon is not effective as the hepatic glycogen stores are usually exhausted by prolonged hypoglycemia