From the FDA Drug Label
The hypoglycemia or hyperglycemia which occurs during octreotide acetate injection therapy is usually mild, but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents Hypoglycemia and hyperglycemia occurred on octreotide acetate injection in 3% and 16% of acromegalic patients, respectively. In patients with concomitant Type I diabetes mellitus, octreotide acetate injection may affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in these patients
The relationship between opioid use and hypoglycemia is not directly addressed in the provided drug labels, which discuss the effects of octreotide acetate injection on glucose regulation. However, based on the information provided about octreotide, hypoglycemia may occur as a result of therapy, particularly in patients with diabetes.
- Key points:
- Hypoglycemia occurred in 3% of acromegalic patients treated with octreotide acetate injection.
- Octreotide acetate injection may affect glucose regulation in patients with diabetes.
- Insulin requirements may be reduced in patients with concomitant Type I diabetes mellitus. 1
From the Research
Opioid use is significantly associated with an increased risk of hypoglycemia, and this relationship is likely a class effect of opioids, as evidenced by a global adjusted Reporting Odds Ratio (aROR) value of 1.53 (95% CI 1.52-1.54) for the 9 opioids studied 2.
Key Findings
- The study found that all 9 opioids analyzed had a statistically significant association with hypoglycemia, with aROR values ranging from 1.09 to 1.97 2.
- Women and diabetics appear to be at higher risk for developing opioid-induced hypoglycemia, with a sex ratio of 0.74 found for reports of opioid-induced hypoglycaemia in VigiBase® 2.
- A case report of methadone-induced hypoglycemia highlights the importance of considering opioid-induced hypoglycemia in patients presenting with hypoglycemic events, particularly if they are taking methadone 3.
- Another case report suggests that naloxone may have a potential role in managing opioid-induced hypoglycemia, as it was found to blunt the hypoglycemic effect in a patient with opioid use disorder 4.
Clinical Implications
- Healthcare providers should be aware of the potential for opioid-induced hypoglycemia, particularly in high-risk patients such as those with diabetes, malnutrition, advanced age, or renal impairment.
- Regular glucose monitoring should be considered in high-risk patients starting opioid therapy, particularly during dose adjustments.
- Alternative pain management strategies may be necessary for patients with recurrent episodes of opioid-induced hypoglycemia.
- The hypoglycemic effect typically resolves with discontinuation of the opioid, though careful monitoring during transition to alternative pain management is recommended.
Management and Prevention
- Immediate administration of glucose (15-20g orally if conscious, or IV dextrose if unconscious) is recommended for patients presenting with opioid-induced hypoglycemia.
- Monitoring blood glucose levels is crucial in managing and preventing opioid-induced hypoglycemia.
- Clinicians should consider altering monitoring parameters in the setting of acute overdoses to include repeated glucose assessment to ensure early identification of hypoglycemia and the potential influence of naloxone 4.