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Toxicity of Oral Agents Used to Treat Diabetes

Boston Medical Center, Boston, Massachusetts

Umbreen Idrees, PharmD

The Johns Hopkins Hospital, Baltimore, Maryland

Oral agents used for the management of type 2 diabetes mellitus include sulfonylureas, biguanides, thiazolidinediones, metglitinides, and/or -glucosidase inhibitors. These medication classes can be further classified as hypoglycemic and antihyperglycemic agents. Hypoglycemia is a major symptom of toxicity of these agents, particularly with the sulfonylureas, including combination medications that include sulfonylureas. In overdose situations, metformin, a biguanide, can lead to considerable gastrointestinal adverse effects and potentially lactic acidosis in severe cases. Data on the management of toxicities of the other classes are limited. This article will review the treatment modalities that have been used for treating symptomatic hypoglycemia and metformin-induced lactic acidosis.

Key Words: Sulfonylurea • metformin • overdose • hypoglycemia • octreotide

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