• Credits
  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

Support us:

1. Support us by purchasing our book - Click here for more details: Volume 1- THE BEST OF NOTES IN ENDOCRINOLOGY BOOK SERIES
2. Support you by Becoming a YouTube member (Click here)

Connected Notes:

• Hypoglycemia in patients with diabetes mellitus

• Definition and Physiology of Hypoglycemia

• Q. How are Sulphonylurea metabolised?

  • They are metabolised via the liver and have active metabolites excreted via the kidney
  • hence both liver dysfunction and renal dysfunction can cause Sulphonylurea induced hypoglycemia
  • They are also protein bound and hence have a longer half-life

• Q. Which are the most common neuroglycopenic symptoms of hypoglycemia?

  • Confusion
  • Personality change

• Q. Which are the most common autonomic symptoms of hypoglycemia?

  • Diaphoresis
  • Tremors

• Q. What kind of hypoglycemia is caused by Sulphonylurea?

  • insulin-dependent hypoglycemia
  • Elevated insulin and c-peptide levels in presence of hypoglycemia is a critical sample

• Q. How is hypoglycemia acutely corrected with IV Dextrose?

  • Adults- 1-2ml/kg (generally 25 gram- 50ml) of 50% dextrose
  • Children - 2-4 ml/kg of 25% dextrose
  • Infant- 5-10 ml/kg of 10% dextrose
  • Once the acute correction is given - continuous glucose infusion is continued

• Q. Which other vitamin must be given with dextrose?

  • If Thiamine deficiency is suspected- give 100 mg IV of thiamine along with the glucose
  • This is to prevent Wernicke's encephalopathy

• Q. Can glucagon be given in this setting?

  • Yes
  • But this is not a substitute for IV Dextrose

• Q. What is done in case of a symptomatic intentional overdose of Sulphonylurea?

  • this must be treated with both IV Dextrose and Octreotide
  • IV dextrose- though important must not be used alone
  • this is because IV dextrose can lead to hyperglycemia → which stimulates the release of insulin further
  • Hence Octreotide must be given along with IV dextrose
  • Octreotide blocks the further release of insulin
  • A continuous IV Dextrose infusion may also be given

• Q. How is Octreotide given?

  • it is given in the dose of 50-100 mcg subcutaneous or IM every 6 hours in adults.
  • In children, it is given 1-1.5 mcg/kg every 6 hrly
  • It can also be given as IV infusion, but subcutaneous or IM is enough in most cases

• Q. How long is Octreotide given?

  • It is given for 24 hours
  • generally not required to repeat after the same
  • If hypoglycemia persists after 24 hours- then repeat Octreotide

• Q. How is IV dextrose infusion given?

  • Adults 5% dextrose - 75-100 ml/hr
  • Children- 6-9 mg/kg/min dextrose infusion

• Q. How is a rate of infusion calculated based on mg/kg/min?

  • Rate of Infusion = (dose required in mg/kg/min x 6 x weight) / Percent dextrose in solution
  • for example 10 kg child, needing 8 mg/kg/min infusion of 10% dextrose- give 48 ml/hr based on the above calculation

• Q. Apart from Octreotide which other medication can be used?

  • Diazoxide
  • But Octreotide is better than Diazoxide

• Q. Is Octreotide also given during a single episode of level 2 or level 3 Sulphonylurea-induced hypoglycemia?

  • No
  • Octreotide is not required for a single episode of Sulphonylurea induced hypoglycemia
  • It is to be given only when there is level 3 hypoglycemia, intentional overdose, or multiple episodes of level 2 hypoglycemia
  • In a single episode- observe the patient for 24 hours- if there is a second episode then give Octreotide else discharge after 24 hours of observation
  • IV dextrose may be given as appropriate and carbohydrate-rich meal may be given