Octreotide treatment for sulfonylurea-induced hypoglycaemia

In reply: Crawford and Perera highlight a very important point with respect to hospital-based treatment of sulfonylurea-induced hypoglycaemia. Whereas, in our article,1 we wished to emphasise the importance of recognising and preventing this condition in primary care settings, we agree that octreotide is an effective therapy in treating this condition. Octreotide inhibits the specific effect of sulfonylureas (glucose-stimulated β-cell insulin release) and prevents rebound hypoglycaemia, which, in this situation, may occur with the use of glucose.2 Case reports, including those elegantly presented and referenced by Crawford and Perera, clearly illustrate the safety and efficacy of octreotide in treating sulfonylurea toxicity when initial therapy with glucose fails. Octreotide may be administered either intravenously or subcutaneously, and its effect is maintained after a short course of therapy.

At our own institution, we have now adopted guidelines for the treatment of refractory sulfonylurea-induced hypoglycaemia, which include the administration of octreotide (50 μg subcutaneously) every 8 hours for up to three doses, although, as Crawford and Perera note, some patients will have a sustained response after a single dose.