An 82-year-old with eGFR 28 mL/min/1.73 m2 has recurrent hypoglycaemia after gliclazide despite IV dextrose. She has eaten poorly for two days. Which

Question

An 82-year-old with eGFR 28 mL/min/1.73 m2 has recurrent hypoglycaemia after gliclazide despite IV dextrose. She has eaten poorly for two days. Which additional management is most appropriate?

Accepted Answer

Stop the sulfonylurea, give octreotide and continue monitored glucose support because recurrent insulin release may persist

Answer

Restrict carbohydrate because repeated glucose administration causes the underlying hypoglycaemia

Answer

Use glucagon as the sole long-term strategy and discharge immediately after one normal reading

Answer

Start metformin during the episode and continue dextrose because metformin directly antagonises sulfonylurea-stimulated insulin release

Answer

Restart gliclazide at the same dose once the first dextrose bolus raises glucose above 4 mmol/L

Sulfonylurea-induced hypoglycaemia — RACP Adult Medicine MCQ

An 82-year-old with eGFR 28 mL/min/1.73 m2 has recurrent hypoglycaemia after gliclazide despite IV dextrose. She has eaten poorly for two days. Which additional management is most appropriate?