Elsevier

Medicine

Volume 44, Issue 3, March 2016, Pages 138-140
Medicine

Specific substances
Antidiabetic drugs

https://doi.org/10.1016/j.mpmed.2015.12.011Get rights and content

Abstract

Over recent years, there has been a rapid expansion of different classes of antihyperglycaemic drugs with diverse toxicological profiles. Insulin and sulfonylurea overdose can cause significant hypoglycaemia, which is reversed by administration of intravenous glucose 10–20%, aiming to achieve a target plasma glucose concentration of ≥4 mmol/litre. However, glucose alone is a potent stimulus for additional insulin release in sulfonylurea-poisoned patients and can result in recurrent and prolonged rebound hypoglycaemia. Octreotide inhibits the secretion of insulin from the pancreas and, when used in sulfonylurea poisoning, is associated with a marked reduction in hypoglycaemic episodes and glucose requirements.

Section snippets

Insulin

Insulin modifies glucose transporter function via its tyrosine kinase-linked receptor. Parenteral administration can cause profound hypoglycaemia and activation of neurohormonal counter-regulatory mechanisms. Overdose can be associated with a significantly longer duration of action than therapeutic doses. A large subcutaneous bolus of insulin, including short-acting formulations, can give rise to prolonged systemic absorption over many hours or days. Inhaled insulin has limited bioavailability

Clinical features

Poisoning by sulfonylureas, biguanides and insulin is associated with moderate to severe poisoning in 4.6%, 12.2% and 14.7% of cases, respectively, and with fatal poisoning in 0.9%, 6.1% and 3.6%, respectively.5

Insulin and sulfonylurea overdose can cause significant hypoglycaemia. There are few published data concerning the effects of meglitinides or SGLT2 inhibitors in overdose, but these are expected to cause significant hypoglycaemia, based upon their pharmacological mechanisms.6 The

Management

Hypoglycaemia should be reversed by administration of intravenous glucose (dextrose) 10–20%, aiming to achieve a target plasma glucose concentration of ≥4 mmol/litre (higher target concentrations may be needed to avoid symptoms in some patients with poorly controlled diabetes). Hypoglycaemia after insulin or antidiabetic drug overdose can persist for much a longer duration than expected after therapeutic doses.7 Prolonged intravenous infusions can be required; these are associated with a risk

References (13)

  • P.J. Boyle et al.

    Octreotide reverses hyperinsulinemia and prevents hypoglycemia induced by sulfonylurea overdoses

    J Clin Endocrinol Metab

    (1993)
  • N.F. Wiernsperger et al.

    The antihyperglycaemic effect of metformin: therapeutic and cellular mechanisms

    Drugs

    (1999)
  • M.B. Forrester

    Pattern of thiazolidinedione exposures reported to Texas poison centers during 1998–2004

    J Toxicol Environ Health

    (2006)
  • M.A. Darracq et al.

    A retrospective review of isolated gliptin-exposure cases reported to a state poison control system

    Clin Toxicol

    (2014)
  • M.A. von Mach et al.

    Antidiabetic medications in overdose: a comparison of the inquiries made to a regional poisons unit regarding original sulfonylureas, biguanides and insulin

    Int J Clin Pharmacol Ther

    (2006)
  • S. Nakayama et al.

    Hypoglycemia following a nateglinide overdose in a suicide attempt

    Diabetes Care

    (2005)
There are more references available in the full text version of this article.

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