Affiliation:
1. Visiting Diabetologist , Grant Govt Medical College And Sir J.J Group Of Hospitals, Mumbai.
Abstract
Hypoglycemia in diabetes is generally the result of interplay of relative or absolute therapeutic exogenous or endogenous insulin excess and
compromised physiological and behavioral defenses against falling blood glucose concentrations. Thus, it is fundamentally iatrogenic, the result of
treatments that include insulin or an insulin secretagogue such as glimepiride. The long-acting, synthetic somatostatin analog, octreotide, can be
used to correct refractory hypoglycemia caused by sulfonylurea. There have been few records of it being used in a clinical environment. We present
a case in which a subcutaneous injection of octreotide was successful in treating sulfonylurea-induced refractory hypoglycemia. The patient was
referred to our hospital for recurrent hypoglycemia caused by sulfonylurea. His medications included tablet glimepiride 4 mg once daily along with
tablet metformin 1000mg once daily. His plasma glucose level on arrival was 45 mg/dl. He was treated with 50 ml of 25% glucose solution and
administered continuous drip of 5% glucose solution through a peripheral vein, but his hypoglycemia recurred several times. Finally, 100 mcg of
octreotide was subcutaneously injected. Thereafter, hypoglycemia did not recur, and additional injections of glucose were not required. The
subcutaneous injection of octreotide can be an effective and safe method of treating prolonged, and refractory hypoglycemia caused by
sulfonylureas and alleviate impending complications, morbidity, and/ or mortality. The octreotide subcutaneous injection can be used as outpatient
department treatment and can greatly reduce the cost of hospitalization.