Sulfonylureas are long-acting agents that stimulate release of insulin from the beta-cells of the pancreas. If hypoglycemia occurs, then it tends to be prolonged (may be over 24 hours) and it tends to be resistant to standard glucose replacement strategies.


Patients at risk for prolonged hypoglycemia:

(1) overdosage

(2) drug-induced interaction (for example, with ciprofloxacin)

(3) frail elderly

(4) chronic renal failure (associated with retention of an active metabolite)


Problems with usual management of hypoglycemia:

(1) The fluid volume required can be a problem for certain patients.

(2) The administration of glucose in high doses results in further release of insulin, causing a rebound hypoglycemia.

(3) Glucagon has little if any benefit in treating it.


Octreotide is a synthetic somatostatin analogue that inhibits release of insulin from the beta cells of the pancreas.


One regimen is 50 micrograms administered subcutaneously given every 8 hours as needed for a total of 3 doses (total time 24 hours). The drug may also be given intravenously.


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