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Hypoglycemic Agent Poisoning

Hypoglycemic Agent Poisoning is a topic covered in the 5-Minute Emergency Consult.

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  • Oral or parenteral agents that may cause hypoglycemia or other metabolic imbalances
  • Hypoglycemic poisoning may be intentional or unintentional (accidental)


  • Insulin:
    • Enhances glucose uptake into cells
    • Limits glucose availability to the brain (most sensitive to hypoglycemia)
    • Influences potassium redistribution (hypokalemia)
  • Sulfonylurea and Meglitinide agents:
    • Enhance insulin release from pancreatic β cells, reduce hepatic glucose production, and increase peripheral insulin sensitivity
    • Hypoglycemic effect enhanced by:
      • Polypharmacy (drug interactions)
      • Alcohol use and hepatic dysfunction (poor nutritional stores)
      • Renal insufficiency (decreased clearance)
  • GLP1 modulators:
    • Exenatide is an analog of glucagon-like peptide 1 (GLP1)
    • Gliptins (sitagliptin and saxagliptin) inhibit DDP4 which normally inactivates GLP1
    • Net effects: Enhanced insulin secretion, delayed gastric emptying, and increased satiety
    • Unclear effects on glucose metabolism in overdose (data are lacking at this time)
  • Biguanide agents (metformin):
    • Antihyperglycemic agents:
      • Decrease elevated serum glucose concentrations
      • Generally do not cause hypoglycemia in isolation.
    • In the presence of insulin, biguanides do the following:
      • Increase glucose uptake into cells
      • Limit glucose availability to the brain (most sensitive to hypoglycemia)
      • Influence potassium redistribution (hypokalemia)
      • Decrease GI glucose absorption
      • Decrease hepatic gluconeogenesis
      • Metabolize glucose to lactate in intestinal cells, which may accumulate and lead to profound lactic acidosis
  • Thiazolidinediones:
    • In the presence of insulin, thiazolidinediones increase glucose uptake and use and decrease gluconeogenesis
  • α-glucosidase inhibitors:
    • Lower systemic glucose by decreasing GI absorption of carbohydrates

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Rosen, Peter, et al., editors. "Hypoglycemic Agent Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307653/all/Hypoglycemic_Agent_Poisoning.
Hypoglycemic Agent Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307653/all/Hypoglycemic_Agent_Poisoning. Accessed April 24, 2019.
Hypoglycemic Agent Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307653/all/Hypoglycemic_Agent_Poisoning
Hypoglycemic Agent Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307653/all/Hypoglycemic_Agent_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hypoglycemic Agent Poisoning ID - 307653 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307653/all/Hypoglycemic_Agent_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -