Oral Hypoglycemic Agent Toxicity Medication

  • Author: David Tran, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Sep 30, 2011
 

Dextrose and glucose stimulators

Class Summary

Prompt gluconeogenesis is achieved with glucagon. Emergent blood glucose elevation requires intravenous dextrose. First-line agent for oral hypoglycemic toxicity is dextrose.

Pancreatic alpha cells of the islets of Langerhans produce glucagon, a polypeptide hormone. Exerts opposite effects of insulin on blood glucose. Glucagon elevates blood glucose levels by inhibiting glycogen synthesis and enhancing formation of glucose from noncarbohydrate sources, such as proteins and fats (gluconeogenesis). Increases hydrolysis of glycogen to glucose (glycogenolysis) in liver in addition to accelerating hepatic glycogenolysis and lipolysis in adipose tissue. Glucagon increases force of contraction in the heart and has a relaxant effect on the GI tract.

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Dextrose (D-glucose)

 

Used to promptly elevate serum glucose. Monosaccharide absorbed from intestine and then distributed, stored, and used by tissues. Parenterally injected dextrose is used in patients who are unable to sustain adequate oral intake. Direct oral absorption results in a rapid increase in blood glucose concentrations. Effective in small doses. No evidence suggests that it may cause toxicity. Concentrated dextrose infusions provide higher amounts of glucose and increased energy intake in a small volume of fluid.

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Glucagon

 

Extracted from beef and pork pancreas. Chemically unrelated to insulin, glucagon is a single-chain polypeptide with 29 amino acid residues and a molecular weight of 3,483. In patients with insulinoma, IV administration of glucagon produces an initial increase in blood glucose; however, because of glucagon's insulin-releasing effect, it may cause the insulinoma to release its insulin and subsequently cause hypoglycemia. Glucagon increases blood glucose concentration and is used to treat hypoglycemia. It is effective in small doses, and no evidence of toxicity has been reported with its use. Glucagon acts only on liver glycogen, converting it to glucose. Parenteral administration of glucagon produces relaxation of the smooth muscle of the stomach, duodenum, small bowel, and colon. The half-life of glucagon in plasma is approximately 3-6 min, similar to that of insulin.

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Insulin secretion inhibiting agents

Class Summary

Insulin secretion may be altered by various mechanisms. Diazoxide inhibits pancreatic secretion of insulin, stimulates glucose release from the liver, and stimulates catecholamine release, which elevates blood glucose levels. It causes a false-negative insulin response to glucagon.

Octreotide is a peptide with pharmacologic action similar to somatostatin, which inhibits insulin secretion.

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Diazoxide (Proglycem, Hyperstat)

 

Increases blood glucose by inhibiting pancreatic insulin release and possibly through an extrapancreatic effect. Hyperglycemic effect begins within an hour and usually lasts a maximum of 8 h with normal renal function.

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Octreotide (Sandostatin)

 

Acts primarily on somatostatin receptor subtypes II and V. A somatostatin analogue, which activates G-protein K channel. Hyperpolarization of the beta cell results in inhibition of Ca influx and insulin release. Octreotide is also used for acromegaly, carcinoid tumors, and Vipomas.

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Contributor Information and Disclosures
Author

David Tran, MD  Attending Physician, Department of Emergency Medicine, North Shore-LIJ Plainview Hospital

David Tran, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael E Mullins, MD  Assistant Professor, Division of Emergency Medicine, Washington University in St Louis School of Medicine; Attending Physician, Emergency Department, Barnes-Jewish Hospital

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians

Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Michael Lucchesi, MD, to the original writing and development of this article.

References

  1. Hanchard B, Boulouffe C, Vanpee D. Sulfonylurea-induced hypoglycaemia: use of octreotide. Acta Clin Belg. Jan-Feb 2009;64(1):56-8. [Medline].

  2. Kane MP, Abu-Baker A, Busch RS. The utility of oral diabetes medications in type 2 diabetes of the young. Curr Diabetes Rev. Feb 2005;1(1):83-92. [Medline].

  3. Pearson ER. Pharmacogenetics in diabetes. Curr Diab Rep. Apr 2009;9(2):172-81. [Medline].

  4. Joslin Diabetes Center. Clinical guideline for pharmacological management of type 2 diabetes. Boston, MA: Joslin Diabetes Center; 2007.

  5. Litovitz TL, Klein-Schwartz W, Caravati EM, et al. 1998 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1999;17(5):435-87. [Medline].

  6. Litovitz TL, Klein-Schwartz W, Dyer KS, et al. 1997 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1998;16(5):443-97. [Medline].

  7. Litovitz TL, Smilkstein M, Felberg L, et al. 1996 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1997;15(5):447-500. [Medline].

  8. Litovitz TL, Felberg L, Soloway RA, et al. 1994 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1995;13(5):551-97. [Medline].

  9. Litovitz TL, Clark LR, Soloway RA. 1993 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1994;12(5):546-84. [Medline].

  10. Litovitz TL, Felberg L, White S, Klein-Schwartz W. 1995 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1996;14(5):487-537. [Medline].

  11. Litovitz TL, Holm KC, Clancy C, et al. 1992 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1993;11(5):494-555. [Medline].

  12. Litovitz TL, Holm KC, Bailey KM, Schmitz BF. 1991 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1992;10(5):452-505. [Medline].

  13. Litovitz TL, Bailey KM, Schmitz BF, et al. 1990 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1991;9(5):461-509. [Medline].

  14. Litovitz TL, Schmitz BF, Bailey KM. 1989 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med. Sep 1990;8(5):394-442. [Medline].

  15. Levine M, Ruha AM, Lovecchio F, et al. Hypoglycemia after accidental pediatric sulfonylurea ingestions. Pediatr Emerg Care. Sep 2011;27(9):846-9. [Medline].

  16. Adam PA, Schwartz R. Diagnosis and treatment: should oral hypoglycemic agents be used in pediatric and pregnant patients?. Pediatrics. Nov 1968;42(5):819-23. [Medline].

  17. Boyle PJ, Justice K, Krentz AJ, et al. Octreotide reverses hyperinsulinemia and prevents hypoglycemia induced by sulfonylurea overdoses. J Clin Endocrinol Metab. Mar 1993;76(3):752-6. [Medline].

  18. Braatvedt GD. Octreotide for the treatment of sulphonylurea induced hypoglycaemia in type 2 diabetes. N Z Med J. May 23 1997;110(1044):189-90. [Medline].

  19. Ferner RE, Chaplin S. The relationship between the pharmacokinetics and pharmacodynamic effects of oral hypoglycaemic drugs. Clin Pharmacokinet. Jun 1987;12(6):379-401. [Medline].

  20. Gjedde S, Christiansen A, Pedersen SB, Rungby J. Survival following a metformin overdose of 63 g: a case report. Pharmacol Toxicol. Aug 2003;93(2):98-9. [Medline].

  21. Goldfrank LR, Flomenbaum NE, Lewin NA, eds. Goldfrank's Toxicologic Emergencies. McGraw-Hill Professional Publishing; 1988:671-87.

  22. Gul M, Cander B, Girisgin S, Ayan M, Kocak S, Unlu A. The effectiveness of various doses of octreotide for sulfonylurea-induced hypoglycemia after overdose. Adv Ther. Nov-Dec 2006;23(6):878-84. [Medline].

  23. Haymond MW. Hypoglycemia in infants and children. Endocrinol Metab Clin North Am. Mar 1989;18(1):211-52. [Medline].

  24. Johnson SF, Schade DS, Peake GT. Chlorpropamide-induced hypoglycemia: successful treatment with diazoxide. Am J Med. Nov 1977;63(5):799-804. [Medline].

  25. Little GL, Boniface KS. Are one or two dangerous? Sulfonylurea exposure in toddlers. Journal of Emergency Medicine. 2005;28:305-10. [Medline].

  26. Pavone L, Mollica F, Musumeci S, et al. Accidental glibenclamide ingestion in an infant: clinical and electroencephalographic aspects. Dev Med Child Neurol. Jun 1980;22(3):366-71. [Medline].

  27. Ramos E, Baron S, Sentanac S. Hypoglycemia associated with oral sulfonylurea hypoglycemic agents in an 11-year-old girl. Archives de Pediatrie. 2005;12:1109-11. [Medline].

  28. Rao NG, Menezes RG, Nagesh KR, Kamath GS. Suicide by combined insulin and glipizide overdose in a non-insulin dependent diabetes mellitus physician: a case report. Med Sci Law. Jul 2006;46(3):263-9. [Medline].

  29. Rowden AK, Fasano CJ. Emergency management of oral hypoglycemic drug toxicity. Emerg Med Clin North Am. May 2007;25(2):347-56; abstract viii. [Medline].

  30. Sarmah AK, Sabadie J. Hydrolysis of sulfonylurea herbicides in soils and aqueous solutions: a review. J Agric Food Chem. Oct 23 2002;50(22):6253-65. [Medline].

  31. Soderstrom J, Murray L, Daly FF, Little M. Toxicology case of the month: oral hypoglycaemic overdose. Emerg Med J. Jul 2006;23(7):565-7. [Medline].

  32. Spiller HA. Management of sulfonylurea ingestions. Pediatr Emerg Care. Jun 1999;15(3):227-30. [Medline].

  33. Spiller HA, Sawyer TS. Toxicology of oral antidiabetic medications. Am J Health Syst Pharm. May 15 2006;63(10):929-38. [Medline].

  34. Spiller HA, Schroeder SL, Ching DS. Hemiparesis and altered mental status in a child after glyburide ingestion. J Emerg Med. May-Jun 1998;16(3):433-5. [Medline].

  35. Spiller HA, Villalobos D, Krenzelok EP, et al. Prospective multicenter study of sulfonylurea ingestion in children. J Pediatr. Jul 1997;131(1 Pt 1):141-6. [Medline].

  36. Szlatenyi CS, Capes KF, Wang RY. Delayed hypoglycemia in a child after ingestion of a single glipizide tablet. Ann Emerg Med. Jun 1998;31(6):773-6. [Medline].

  37. Trenque T, Hoizey G, Lamiable D. Serious Hypoglycemia: Munchausen's Syndrome?. Diabetes Care. 2001;24:792-3.

 
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Normal hypoglycemic counterregulation.
Table. The American Association of Poison Control Centers' National Data Collection System from 1989-1997
YearExposures< 6 Years6-19 YearsUnintentional ExposuresOverall Mortality*Pediatric Mortality
19891467808† 130113910
19901601910† 120126511
199120131143† 158157730
199223411310† 143182420
199322721207180179410
199424821246192194581
199528151381230221430
199633331468276259440
199738461619370303341
Total2217011092179917385273
*Overall mortality includes adult and pediatric cases



† Denotes patients aged 6-17 years



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