Toxicology of Medications for Diabetes Mellitus

Kevin Baumgartner; Jason Devgun

doi:10.1016/j.ccc.2021.03.007

Toxicology of Medications for Diabetes Mellitus

Crit Care Clin. 2021 Jul;37(3):577-589. doi: 10.1016/j.ccc.2021.03.007.

Authors

Kevin Baumgartner¹, Jason Devgun²

Affiliations

¹ Department of Emergency Medicine, Division of Medical Toxicology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8072, St Louis, MO 63110, USA. Electronic address: baumgartner.k@wustl.edu.
² Department of Emergency Medicine, Division of Medical Toxicology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8072, St Louis, MO 63110, USA.

PMID: 34053707
DOI: 10.1016/j.ccc.2021.03.007

Abstract

Medications used to treat diabetes mellitus are heterogeneous, with widely differing safety profiles in therapeutic use and in overdose. Insulin overdose may produce severe and prolonged hypoglycemia. Sulfonylurea poisoning should be treated with octreotide, sparing intravenous dextrose where possible. Acute metformin overdose may lead to life-threatening acidosis with elevated lactate concentrations, which may require hemodialysis. Glucagon-like peptide 1 agonists and dipeptidyl peptidase 4 inhibitors are benign in overdose in diabetic patients but may produce profound hypoglycemia in nondiabetic patients. Euglycemic diabetic ketoacidosis may develop in critically ill patients taking sodium-glucose co-transporter 2 inhibitors.

Keywords: Diabetes mellitus; Insulin; Metformin; Overdose; Poisoning; SGLT2 inhibitor; Sulfonylurea; Toxicology.

Publication types

Review

MeSH terms

Diabetes Mellitus*
Dipeptidyl-Peptidase IV Inhibitors* / therapeutic use
Humans
Hypoglycemic Agents / therapeutic use
Metformin*
Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use

Substances

Dipeptidyl-Peptidase IV Inhibitors
Hypoglycemic Agents
Sodium-Glucose Transporter 2 Inhibitors
Metformin