Octreotide for the Treatment of Sulfonylurea-Associated Hypoglycemia

Methods: All adult (\>18 years old) non-pregnant patients presenting to the Emergency Department with hypoglycemia (serum glucose \< 60 mg/dl) will be identified and screened for inclusion by the ED physicians and research staff. Hypoglycemic patients whose glucose-control medications involve only insulin will be excluded. All patients whose medications involve oral sulfonlyureas or a combination of insulin and sulfonylureas will be asked to participate in this study. Patients will be required to read and sign an informed consent outlining the objectives and risks/ benefits of the proposed protocol. In addition to reading the consent, details of the study will be explained verbally by a trained emergency medicine research assistant and patients will be given the opportunity to have all their questions answered. Study patients will be randomized to one of two treatment arms. 1. Standard treatment and placebo One ampule (50 mL) of IV 50% dextrose, oral carbohydrates and placebo (1cc of 0.9 % Normal Saline subcutaneuously) or 2. Standard treatment plus 75 micrograms octreotide subcutaneously. Enrolled patients will not receive additional maintenance IV glucose fluids unless they become hypoglycemic (serum glucose \< 60 mg/dL), in which case they will receive bolus doses of IV 50% dextrose and re-evaluated. All enrolled patients will be admitted to the hospital and monitored for recurrent hypoglycemic episodes. Bedside glucose determinations will be collected hourly for 4 hours followed by repeated calculations every 2 hours. Data points to be collected will include the mean serum glucose, number of hypoglycemic episodes (\<60mg/dl) and total quantity of dextrose required to maintain euglycemia. In the likely event that the hypoglycemia was diagnosed in the pre-hospital setting and the patient received IV 50% dextrose prior to arrival to the Emergency Department, a rapid bedside glucose determination will be obtained and if \<60 mg/dl a second bolus of IV 50% dextrose given and the patient screened and approached about participation. If the emergency department serum glucose is \>60mg/dl the patient will be screened and approached about participation without a second bolus of IV 50% dextrose.