Yes, octreotide is indicated in the treatment of sulfonylurea-induced hypoglycemia¹.

Sulfonylureas are widely used in the treatment of type 2 diabetes mellitus. Hypoglycemia is a known potential adverse effect which may be prolonged and recurrent, and last for days after ingestion.^1,2 The risk is higher in elderly patients, renal or hepatic dysfunction, alcohol use, and polypharmacy, as observed with certain antibiotics.^3,4

The mode of action of sulfonylureas is through binding to SUR1 receptors on the pancreatic β-cell membrane which leads to an inhibition of ATP-dependent potassium efflux channels. This results in membrane depolarization, opening voltage-gated calcium channels which in turn triggers insulin release.¹ Sulfonylureas are metabolized in the liver and are renally cleared, thus hepatorenal dysfunction can increase the magnitude and duration their action.²  Octreotide binds to somatostatin receptors on pancreatic β-cells, which closes the voltage-gated calcium channels, preventing insulin release.¹

Treatment for sulfonylurea-induced hypoglycemia begins with carbohydrate administration, with oral glucose or IV dextrose boluses and infusion.¹ Octreotide should be used in acute overdose as well in refractory hypoglycemia.⁵ In fact, the administration of carbohydrates can cause a transient hyperglycemia which potentiates further insulin release, leading to recurrent rebound hypoglycemia.¹

Octreotide can be given subcutaneously or IV with equivalent bioavailability. The typical dose is 50-100 micrograms every 6-12 hours, with 12-72 hours of therapy usually considered adequate. Serum glucose should be closely monitored during treatment and at least for 16-24 hours afterwards. The good news is that octreotide is generally well tolerated, and, in most cases, adverse effects are mild including hyperglycemia, injection site pain, and GI upset.^1,2,5

Bonus Pearl:

Did you know that sulfonylureas are also widely used as herbicides? Herbicidal sulfonylureas disrupt the synthesis of branched chain amino acids via inhibition of AHAS, an enzyme present in plants, bacteria, and fungi. There is low toxicity to humans and animals as our bodies lack this enzyme.⁶

Contributed by Tony Hiran, MD, Mercy Hospital, St. Louis, MO

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References

1. Dougherty PP, Klein-Schwartz W. Octreotide’s role in the management of sulfonylurea-induced hypoglycemia. J Med Toxicol 2010;6:199-206. doi: 10.1007/s13181-010-0064-z. PMID: 20352540; PMCID: PMC3550273.
2. Gonzalez RR, Zweig S, Rao J, Block R, Greene LW. Octreotide therapy for recurrent refractory hypoglycemia due to sulfonylurea in diabetes-related kidney failure. Endocr Pract 2007;13:417-23. doi: 10.4158/EP.13.4.417. PMID: 17669721.
3. Harrigan RA, Nathan MS, Beattie P. Oral agents for the treatment of type 2 diabetes mellitus: pharmacology, toxicity, and treatment. Ann Emerg Med 2001; 38:68-78. doi: 10.1067/mem.2001.114314. PMID: 11423816.
4. Pearls4Peers. My patient is being treated for a urinary tract infection with trimethoprim-sulfamethoxazole (TMP-SMX) and has developed hypoglycemia — can it be related? Pearls4Peers. 2016 Jul 27. Available from: https://pearls4peers.com/2016/07/27/my-patient-is-being-treated-for-a-urinary-tract-infection-with-trimethoprim-sulfamethoxazole-tmp-smx-and-has-developed-hypoglycemia-can-it-be-related/ [Accessed 1st January 2026].
5. Glatstein M, Scolnik D, Bentur Y. Octreotide for the treatment of sulfonylurea poisoning. Clin Toxicol (Phila) 2012;50:795-804. doi: 10.3109/15563650.2012.734626. Epub 2012 Oct 10. PMID: 23046209.
6. Lonhienne T, Garcia MD, Pierens G, Mobli M, Nouwens A, Guddat LW. Structural insights into the mechanism of inhibition of AHAS by herbicides. Proc Natl Acad Sci U S A. 2018;115:E1945-E1954. doi: 10.1073/pnas.1714392115. Epub 2018 Feb 13. PMID: 29440497; PMCID: PMC5834681.

Disclosures/Disclaimers: The listed questions and answers are solely the responsibility of the author and do not necessarily represent the official views of Mercy Hospital-St. Louis, Massachusetts General Hospital, Harvard Catalyst, Harvard University, their affiliate academic healthcare centers, or its contributors. Although every effort has been made to provide accurate information, the author is far from being perfect. The reader is urged to verify the content of the material with other sources as deemed appropriate and exercise clinical judgment in the interpretation and application of the information provided herein. No responsibility for an adverse outcome or guarantees for a favorable clinical result is assumed by the author. Thank you!