Tox: Diabetes meds

Question 1

Mechanism of sulfonylurea toxicity

Answer 1

Promotes increased secretion of insulin from pancreatic beta-islet cells –> hypoglycemia.
Hepatic/renal impairment and drug interactions may result in toxicity.

Question 2

Symptoms of sulfonylurea toxicity

Answer 2

May take hours for peak effect with hypoglycemia delayed as long as 24hrs post ingestion.
Present w/ symptoms of hypoglycemia (+HR, diaphoretic, n/v, AMS, seizures).

Question 3

What concurrent medication might mask sulfonylurea toxicity?

Answer 3

Beta blockers

Question 4

How does octreotide work in sulfonylurea toxicity?

Answer 4

Long-acting synthetic analogue of somatostatin that inhibits release of insulin from pancreas thus, counteracting sulfonylurea induced insulin release.

Decreases dextrose requirements and prevents further episodes of hypoglycemia.

Give 50-100mcg SC or IV bolus then repeat q6? prn OR start infusion. Duration typically 24hrs.

Question 5

Treatment of sulfonylurea overdose

Answer 5

Activated charcoal.
Dextrose boluses to maintain normal glucose.
Octreotide.

Question 6

Monitoring for children that have ingested sulfonylurea.

Answer 6

Single tab can result in life threatening hypoglycemia.
Children must be observed for at least 12 hrs, potentially longer if there is any hypoglycemia or requirement for glucose administration.

Question 7

Complication if sulfonylurea consumed with alcohol

Answer 7

Disulfuram reaction (HA, flushing, n/v)

Question 8

Metformin MOA

Answer 8

1) increases peripheral glucose uptake
2) Reduces hepatic gluconeogenesis
3) Reduces intestinal absorption of glucose

Question 9

Symptoms of metformin OD

Answer 9

Lactic acidosis with n/v, malaise, tachypnea

Question 10

Treatment of metformin OD

Answer 10

HD if severe lactic acidosis (more likely to occur if there is underlying ARF)