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Recurrent sulfonylurea-induced hypoglycaemia — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesRecurrent sulfonylurea-induced hypoglycaemiaSCE Acute Medicine

A 70-year-old man taking gliclazide is found confused and sweaty. Capillary glucose is 1.8 mmol/L and he improves after IV glucose, but hypoglycaemia recurs twice over the next four hours despite eating. Renal function is reduced with eGFR 28 mL/min/1.73 m2. What is the most appropriate next step in management?

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Correct answer: A — Admit for prolonged monitoring and give octreotide after recurrent sulfonylurea hypoglycaemia

Sulfonylurea-induced hypoglycaemia can be prolonged, especially in renal impairment, and octreotide suppresses insulin release after recurrent episodes. A single corrected glucose is not reassuring. Glucagon may transiently raise glucose but can stimulate further insulin secretion and is not definitive. The pearl is to identify the drug mechanism rather than repeatedly giving dextrose alone.

Reference: TOXBASE sulfonylurea poisoning, BNF