Drug-Induced Glucose Alterations Part 1: Drug-Induced Hypoglycemia

TLDR

Abstract

Many pharmacological agents commonly used in clinical practice affect glucose homeostasis, interfering with the body's balance between insulin, glucagon, catecholamines, growth hormone, and cortisol. Drug-induced serum glucose alterations manifested as hyperglycemia or hypoglycemia and ranging from mild to moderate to severe symptoms either appearing acutely or chronically, have perpetual effects on the body, particularly in patients with diabetes. This article and a second one that will appear in the next issue of this journal review drug-induced serum glucose alterations in a two-part series. In this article, we review pertinent clinical information on the incidence of drug-induced hypoglycemia and discuss the underlying pathophysiological mechanisms involved. Hypoglycemia is clinically defined as a serum glucose concentration low enough to cause the signs and symptoms differentiated in Table 1.1–4 Depending on the severity, hypoglycemic symptoms include irritability, impaired concentration, neurological deficits, seizures, coma, and even neuronal death.5 However, clinical manifestations vary from individual to individual, and some report hypoglycemic symptoms even when serum glucose levels do not reflect hypoglycemia or vice versa. Although definitions of hypoglycemia differ in the literature, many trials will differentiate between hypoglycemia (asymptomatic and symptomatic low serum glucose levels) and severe hypoglycemia. This article will cover and report both when applicable. The American Diabetes Association (ADA) Workgroup on Hypoglycemia has defined and classified hypoglycemia based on the severity of symptoms in patients diagnosed with diabetes as outlined in Table 2.2 In general, severe hypoglycemia develops when a reduction in blood glucose is enough to require assistance from another person to actively administer carbohydrate, glucagon, or other corrective actions.2 Severe hypoglycemia is a serious clinical syndrome that continues to be the most common endocrine emergency faced by health care providers and remains the limiting factor in effective diabetes management for many patients.6 …