We report a case of fatal hypoglycemia related to levofloxacin administration in an elderly patient with diabetes. Hypoglycemia is most often caused by drugs taken to control diabetes. Low blood glucose or hypoglycemiatreatmentrecovery. Prescribers should strive to avoid these adverse events particularly in elderly patients, patients with sepsis, renal or hepatic disease, or in patients on insulin and sulfonylureas. But controlling blood glucose is more than just managing the highs. Sometimes hypoglycemia symptoms occur after certain meals high in sugar because your body produces more insulin than you need. Although several medications can cause the condition, druginduced diabetes is often caused by drugs used to treat diabetes. The risk of permanent neurologic deficits increases with prolonged hypoglycemia. This can be as the result of a diabetic who accidentally.
The main complication of insulin secretagogues is hypoglycemia. Risk factors for hypoglycemia are aging, past history of cardiovascular disease or stroke, impaired renal function, and reduced food intake box 5. Trimethoprimsulfamethoxazoleinduced hypoglycemia in a. Drugs that rarely, if ever, cause hypoglycemia diabetics not being treated with pills or insulin rarely need to worry about hypoglycemia. When the liver is metabolizing alcohol, it is less able to break down glycogen to make glucose when blood glucose levels drop. However, not all drugs affect patients the same way. Druginduced low blood sugar is low blood glucose that results from taking medicine. Druginduced hypoglycemia definition of druginduced. Independent of perceptable simultaneous symptoms, hypoglycemia is defined as a blood glucose measurement in capillary blood below 40 mgdl 2.
Approach to hypoglycemia in infants and children ncbi. It can be caused by too much insulin intake or oral hypoglycemic agents or too little food or excessive physical activity 2. Sep 25, 2007 hypoglycemia occurs when the blood sugar level is too low. Bactrim induced hypoglycemia is a well reported drugdrug interaction in patients with diabetes treated with sulfonylureas. Symptoms related to the brain starving for sugar headache, dizziness, blurred vision, difficulty concentrating, poor coordination, confusion, weakness or fainting, tingling sensations in the lips or hands, confused speech, abnormal behavior, convulsions, loss of consciousness, coma. As i walked into the store, i saw a lady sitting in a chair.
Unrecognized infection causing hypoglycemia in patients with diabetes may result in recurrent hypoglycemic spells or progression of the infection. It is later followed by insulinopenia and hyperglycemia, which occasionally is persistent. This medicine is used as an emergency treatment for severe low blood sugar in diabetic patients, especially if they are not able to take sugar by mouth. Hypoglycemia or low blood sugar is a problem that arises in the management of diabetes. The sulfamethoxazole smx component of bactrim can induce hypoglycemia by stimulating pancreatic cells to secrete insulin. This type of hypoglycemia, called reactive hypoglycemia or postprandial hypoglycemia, can occur in people who have had stomach bypass surgery. Taking someone elses oral diabetes medication accidentally is a possible cause of hypoglycemia. In rare cases, nondiabetesrelated medicines may cause hypoglycemia. What causes a low blood sugar level hypoglycemia low blood sugar may be caused by. What are the diabetes drugs linked to hypoglycemia. Although hypoglycaemia is a well known adverse effect of antidiabetic agents, it may occasionally develop in the course of treatment with drugs used in everyday clinical practice, including nsaids, analgesics, antibacterials, antimalarials, antiarrhythmics, antidepressants and other miscellaneous agents. Hypoglycemia treatment treatment for low blood glucose. The glucose level at which an individual becomes symptomatic is highly variable threshold generally at hypoglycemia eg, new medications, insulin usage or ingestion of an oral hypoglycemic agent, possible toxic ingestion.
Know the treatment, recovery, prevention and complications of low blood glucose or hypoglycemia. Druginduced hepatotoxicity and nephrotoxicity may lead in certain circumstances to hypoglycaemia. Hypoglycemia is found among people who take naltrexone hydrochloride, especially for people who are male, 4049 old, have been taking the drug for 1 6 months, also take medication abilify, and have chronic fatigue syndrome. Even when diabetes is managed very carefully, the medications used to treat diabetes can result in druginduced hypoglycemia. Metformin induced hypoglycemia has been linked previously to metformin overdose, but the presence of other coingestions e. At this stage, most patients require ex ogenous insulin therapy to achieve optimal glucose control abraira et al, 1995.
In type 1 diabetics this is usually caused by taking too much insulin or doing more exercise than expected. Serious injuries may occur if severe hypoglycemia occurs while operating a motor vehicle, heavy machinery, or while engaging in other highrisk activities. Since other drugs have been found to be as effective in treating pneumocystis. Sep 05, 2018 druginduced hypoglycemia can be prevented in nondiabetic individuals by avoiding drugs intended to reduce blood glucose levels, as well as through proper management of diet and exercise in individuals with diabetes. As you can learn in the causes article, hypoglycemia causes fall into two categories. Feb 28, 2020 hypoglycemia also triggers the release of body hormones, such as epinephrine and norepinephrine. Many of these drugs, and depending on clinical setting, may also induce hyperglycaemia. Nov 20, 2012 drugs are the most frequent cause of hypoglycaemia in adults. Severe hypoglycemia remains relatively uncommon with oral insulin secretagogues at a rate of. The risk of hypoglycemia is also related to the pharmacological halflife of the medication and to the time it is bound to the sur. Other medications can cause hypoglycemia, especially in children or in people with kidney failure. The release of these hormones causes additional symptoms of tremor, sweating, rapid heartbeat, anxiety and hunger. Druginduced hypoglycemia drug induced hypoglycemia. Druginduced hypoglycemia can be severe and may cause significant morbidity.
Druginduced hypoglycemia can be prevented in nondiabetic individuals by avoiding drugs intended to reduce blood glucose levels, as well as through proper management of diet and exercise in individuals with diabetes. When you think about diabetes and blood glucose control, the first thing that comes to mind is probably avoiding high blood glucose levels. Some drugs may also induce hypoglycaemia by causing pancreatitis. Clinicians should be cognizant of this potential adverse effect in patients with diabetes who are receiving levofloxacin therapy. Review of literature for the evaluation and management of nondiabetic hypoglycemia using medline and pubmed. Hypoglycemia in people without diabetes is much less common. Bactrim induced severe hypoglycemia in a dietcontrolled. Hypoglycemia middle east journal of family medicine. This case represents the second report in which a patient experienced tmpsmxinduced hypoglycemia that resolved after the dosage was adjusted for the patients decreased renal function. However, reports are rare in the absence of diabetes medications. Low blood sugar hypoglycemia is common in people with diabetes who are taking insulin or other medicines to control their diabetes. The most common cause is medications taken by people with diabetes. Yes, some type 2 diabetics control their condition with diet and exercise alone, without drugs.
Can cause cough due to increased bradykinin can try different med in same class. What to do if someone is experiencing hypoglycemia. After all, the hallmark of diabetes is high blood glucose, or hyperglycemia. Diabetics not being treated with pills or insulin rarely need to worry about hypoglycemia. In addition to causing hypoglycemia, this can increase the severity of hypoglycemia. Hypoglycemia and hypoglycemic syndromes clinical gate. Druginduced hypoglycemia is a significant adverse effect that may cause important morbidity. This case involved a 73yearold comatose white man initiated on highdose tmpsmx for nosocomial pneumonia caused by stenotrophomonas maltophilia. Ace inhibitors, when taken with antidiabetic drugs, can cause hypoglycemia possibly by improving insulin sensitivity. Druginduced hyperglycemia and hypoglycemia, nonprescription. This may result in a variety of symptoms including clumsiness.
Very low quality evidence supports the association between numerous drugs and hypoglycemia. Much less common causes of hypoglycemia include other drugs, critical illness or organ failure, a reaction to carbohydrates in susceptible people, an insulinproducing tumor in the pancreas, and some types of bariatric weight loss surgery. Your brain relies on these hormones to raise blood sugar levels. Approximately 10% of type 1 diabetics are affected by severe hypoglycemic episodes each year, and it is a major barrier to maintaining optimal glycemic control in type. Feb 26, 2019 hypoglycemia or low blood sugar is a problem that arises in the management of diabetes. Druginduced hypoglycaemia is usually mild but may be severe. Insulin insulininduced hypoglycemia accounts for the majority of patients in whom a diagnosis of clinical hypoglycemia is made and is usually an undesired sideeffect of the treatment of diabetes. Druginduced hypoglycemia results when the condition is caused by drugs or medications. The condition may also occur when someone without diabetes takes a medicine used to treat diabetes.
Age and sex distribution druginduced hypoglycemia can occur in individuals of all age groups. Your treatment plan for hypoglycemia low blood sugar depends on what is causing your blood sugar level to drop too low. Incidence and risk factors for hypoglycemia during fetaltoneonatal transition in premature infants. Jun 11, 2019 one of the most important treatment methods for low blood glucose or hypoglycemia is to restore the sugar levels to the normal parameters in the blood, generally, it ranges from 70 to 110 milligramsdl. Fatal hypoglycemia associated with levofloxacin friedrich. Will you have hypoglycemia with naltrexone hydrochloride. The unregulated use of drugs, such as insulin and sulfonylureas intended to control blood glucose levels in individuals with diabetes, disrupts the bodys use of glucose in blood, and causes it to drop to very low levels, leading to druginduced hypoglycemia. Left untreated, hypoglycemia can lead to neurological damage and coma. Drugs and hypoglycemia 3 of type 2 diabetes, there is ultimately a progressive loss of pancreatic bcell function and endogenous insulin secretion.
Administration of these agents to individuals with diabetes mellitus is of most concern. However, chronic hyperglycemia as seen among infants of diabetic mothers can lead to increased insulin secretion 1. Diabetes mellitus usually describes a persistently high blood. The medical literature contains countless articles on druginduced hyperglycemia and hypoglycemia ranging from case reports to observational and randomized, controlled studies. Jan 31, 2017 consuming alcohol can cause hypoglycemia in people who take insulin or a secretagogue. Hypoglycemia associated with drugs endocrinology a state of v serum glucose linked to use of various therapeuticseg, sulfonylureas, oral hypoglycemicseg chlorpropamide, tolbutamide, tolazamide, acetohexamide, alcohol, aspirin, phenformin, insulin. Phenylbutazone can cause severe hypoglycemia when given together with oral sulfonylureas, due to displacement of these agents from plasma protein binding sites and inhibition of their metabolic clearance. Hypoglycemia, also known as low blood sugar, is a fall in blood sugar to levels below normal. Acute and chronic alcohol consumption can also affect metabolic clearance of some hypoglycemics, further contributing to loss of glycemic control. Druginduced hypoglycemia multimedia encyclopedia health. To describe the evaluation and management of hypoglycemia in patients without diabetes. Two conditions that can affect people without diabetes are postprandial syndrome and reactive hypoglycemia. Effects seen win 1 hr of admin, max effects in 6 hrs.
Hypoglycemia hormonal and metabolic disorders merck. A multitude of drugs have been reported as being associated with hyperglycemia or hypoglycemia. Yes, some type 2 diabetics control their condition with diet and. Sep 12, 2019 hypoglycemia is a clinical situation characterized by a reduction in plasma glucose concentration to a level that may induce symptoms or signs such as altered mental status andor sympathetic nervous system stimulation. In this populationbased cohort study, researchers used data from u. Other than certain medicines, the following can also cause blood sugar glucose level to drop. Understanding hypoglycemia how to manage your diabetes. Jul 10, 2007 a number of drugs apart from the sulfonylureas can occasionally cause hypoglycemia, especially when ingested in large amounts. Diabetes mellitus usually describes a persistently high blood sugar. We recommend tailored and structured patient edu cation to ensure adequate knowledge about the causes and management of hypoglycaemia. Acute sequelae of hypoglycemia can include coma, cardiac dysrhythmia, and death. As with other fluoroquinolones, levofloxacin can cause profound and prolonged hypoglycemia. Hypoglycemia is most common in people with diabetes. Drugs inducing hypoglycemia 363 insulin is the most potent hypoglycemic agent known, and is the principal hormone controlling glucose homeostasis.
Acute mountain sickness ams can present with a wide variety of symptoms in unacclimatized persons who rapidly ascend to altitudes 2500 m. These include quinine, quinidine, disopyramide, and salicylates. Jan 01, 2011 administration of these agents to individuals with diabetes mellitus is of most concern. Effective clinical management can be handled through awareness of this druginduced adverse effect on blood glucose levels. Drugs are the most frequent cause of hypoglycaemia in adults.
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