Hypoglycemic Agent Poisoning
Basics
Description
Description
- Oral or parenteral agents that may cause hypoglycemia or other metabolic imbalances
- Hypoglycemic poisoning may be intentional or unintentional (accidental)
Etiology
Etiology
- 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, saxagliptin, and linagliptin) 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
- Antihyperglycemic agents:
- Sodium glucose cotransporter-2 inhibitors:
- Canagliflozin, empagliflozin
- Interfere with renal reuptake of filtered glucose
- Cause osmotic diuresis, but typically euglycemic when used as monotherapy:
- Can potentiate effects of insulin/sulfonylureas
- Can result in significant hypoglycemia in combination
- Reported to cause Euglycemic DKA
- 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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Citation
Schaider, Jeffrey J., et al., editors. "Hypoglycemic Agent Poisoning." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307653/all/Hypoglycemic_Agent_Poisoning.
Hypoglycemic Agent Poisoning. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307653/all/Hypoglycemic_Agent_Poisoning. Accessed December 11, 2024.
Hypoglycemic Agent Poisoning. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307653/all/Hypoglycemic_Agent_Poisoning
Hypoglycemic Agent Poisoning [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 11]. 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
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T1 - Hypoglycemic Agent Poisoning
ID - 307653
ED - Barkin,Adam Z,
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ED - Rosen,Peter,
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ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
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PB - Lippincott Williams & Wilkins
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DB - Emergency Central
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