FEATURES, PREVENTION AND MANAGEMENT OF ACUTE OVERDOSE DUE TO ANTIDIABETIC DRUGS

Hypoglycaemic medication forms a disparate group of therapeutic compou nds including insulin, the sulphonylureas and biguanides. They are all designed to prevent hyperglycaemia and in general are well tolerated. Careful prescribing practice and patient education by the physician c an do much to reduce the risk of adverse effects from diabetic therapy . However, the presentation of adverse effects, together with accident al and non-accidental overdose, is a frequent clinical problem. Furthe rmore, the possible impairment of hypoglycaemic awareness in patients prescribed human insulin has added complexity to diabetic management. The cardinal features of insulin overdose are hypoglycaemia and hypoka laemia. The sulphonylureas predominantly cause hypoglycaemia, while th e biguanides may precipitate lactataemia and acidosis. Recognition of hypoglycaemia is therefore crucial in avoidance of toxicity. Intraveno us dextrose is the mainstay of therapy following gut decontamination ( for the oral agents). The efficacy of glucagon is dependent on hepatic glycogen stores and should therefore be used with caution. Diazoxide is not recommended. More recently, octreotide has been shown to be eff ective in sulphonylurea overdose. Patients should be admitted and moni tored with serial blood sugar measurements for a minimum of 1 to 2 day s as clinically warranted.