Drugs and Hypoglycemia

Manifested hypoglycemia is relatively frequent cause of out-patient office visit at general practitioner, diabetologist and in severe cases represents emergent situation requiring transport to hospital and hospitalization. Severe and untreated hypoglycemia can even lead to death. The aetiology of hypoglycemia is variable, and includes drugs, insulinoma, liver failure, renal failure, hormonal deficiencies, alcohol abuse and reactive hypoglycemia. The medication history is an integral part in the evaluation of a patient with hypoglycemia. A variety of medications have been associated with hypoglycemia, and the list of these medications is expanding (Comi, 1993). The common causes of acute hypoglycemia are related to therapy for diabetes mellitus – insulin and its analogues or oral antidiabetic drugs (OAD). Determining the aetiology of hypoglycemia poses little difficulty in patients known to be taking parenteral or oral hypoglycaemic agents. Severe hypoglycemia, associated with coma or requiring assistance of another person for reversal occurs at least once a year in 10% of patients treated with insulin, with a mortality of 2-4%. There is difficulty assessing the absolute rates but the frequency of iatrogenic hypoglycemia is substantially lower in type 2 than in type 1 diabetes. Thus, the rates of severe hypoglycemia in type 2 diabetes are approximately 10% of those in type 1 diabetes even during aggressive insulin therapy (Marks, 1981). Episodes of hypoglycemia may occur also in patients without diabetes mellitus, insulin or OAD therapy. In these patients, hypoglycemia absents often among diagnostic concerns what might worsen subsequently their prognosis. It is necessary to consider the possibility of drug induced hypoglycemia after excluding its organic aetiology (endocrinopathies, malnutrition, cancer etc.). There are various groups of drugs with provable hypoglycemic effects that may potentiate diabetes mellitus treatment or lead to hypoglycemia in nondiabetic patients as well (Table 1). Some prospective studies carried out in last decade