Contributor: Dylan Luyten, MD

Educational Pearls:

• Insulin related hypoglycemia can vary from a brief transient effect from short-acting forms (i.e. insulin lispro) to prolonged from long acting (i.e. insulin glargine), and will require different treatment and/or observation
• Of oral glycemic agents, sulfonylureas are a common culprit while metformin is rarely a cause
• Sulfonylureas also deserve attention because in pediatric patients, they can be lethal even with a single ingestion, but also can cause severe hypoglycemia in adults
• Hypoglycemia in non-diabetics usually occurs in the malnourished, or in those with liver or adrenal disease

References

Klein-Schwartz W, Stassinos GL, Isbister GK. Treatment of sulfonylurea and insulin overdose. Br J Clin Pharmacol. 2016;81(3):496–504. doi:10.1111/bcp.12822

Tourkmani AM, Alharbi TJ, Rsheed AMB, AlRasheed AN, AlBattal SM, Abdelhay O, Hassali MA, Alrasheedy AA, Al Harbi NG, Alqahtani A. Hypoglycemia in Type 2 Diabetes Mellitus patients: A review article. Diabetes Metab Syndr. 2018 Sep;12(5):791-794. doi: 10.1016/j.dsx.2018.04.004. Epub 2018 Apr 12.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD