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Hypoglycemia Secondary to Sulfonylurea Ingestion in a Patient with End Stage Renal Disease: Results from a 72-Hour Fast.

Abraham A, Rubin M, Accili D, Bilezikian JP, Pajvani UB - Case Rep Endocrinol (2015)

Bottom Line: Past medical history includes multiple myeloma, congestive heart failure, and hypertension.The sulfonylurea screen ultimately returned positive for glipizide, clinching the diagnosis.This is the first reported case which characterizes the chronic elevation of proinsulin in a patient with ESRD, as well as its dramatic increase after a presumed solitary exposure to sulfonylurea.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.

ABSTRACT
Insulin, proinsulin, and C-peptide levels increase with sulfonylurea exposure but the acuity of increase has not been described in dialysis patients. We present a case of a dialysis patient who presented with hypoglycemia and was found to have accidental sulfonylurea ingestion. This is a 73-year-old man with ESRD on peritoneal dialysis, without history of diabetes, who presented with hypoglycemia. Past medical history includes multiple myeloma, congestive heart failure, and hypertension. At initial presentation, his blood glucose was 47 mg/dL, with concomitant elevations in the following: C-peptide 30.5 (nl: 0.8-3.5 ng/mL), insulin 76 (nl: 3-19 μIU/mL), and proinsulin 83.3 (nl: ≤8.0 pmol/L). During the 72-hour fast, which he completed without hypoglycemia, insulin declined to be within normal limits (to 12 μIU/mL); proinsulin (to 12.1 pmol/L) and C-peptide (to 7.2 ng/mL) levels decreased but remained elevated. The sulfonylurea screen ultimately returned positive for glipizide, clinching the diagnosis. This is the first reported case which characterizes the chronic elevation of proinsulin in a patient with ESRD, as well as its dramatic increase after a presumed solitary exposure to sulfonylurea. The 72-hour fast conducted gives insight into the clearance of insulin, proinsulin, and C-peptide after sulfonylurea ingestion in ESRD.

No MeSH data available.


Related in: MedlinePlus

Decline of C-peptide, insulin, and proinsulin observed during 72-hour fast.
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fig1: Decline of C-peptide, insulin, and proinsulin observed during 72-hour fast.

Mentions: During the 72-hour fast, insulin levels rapidly declined within 24 hours to normal; proinsulin and C-peptide levels fell in parallel but remained abnormally high (Table 1 and Figure 1). The patient completed the fast without developing further hypoglycemia or neuroglycopenic symptoms. The sulfonylurea screen, obtained at the time of admission, was positive for glipizide (performed by ARUP laboratories, positive at concentrations greater than 5 ng/mL). The patient and family denied inadvertent use of glipizide. The patient was discharged with new prescriptions in case there was a pharmacy error. When the patient returned for outpatient laboratory testing 1 week later, the repeated values were similar to those obtained at the end of the fast, with persistently elevated fasting C-peptide (8.8 ng/mL) and proinsulin (10.7 pmol/L) but normal insulin (14 μIU/mL) levels. He denied any recurrent hypoglycemia symptoms one week after hospital discharge. Furthermore, during subsequent admissions for worsening congestive heart failure, he exhibited no further signs or symptoms of hypoglycemia.


Hypoglycemia Secondary to Sulfonylurea Ingestion in a Patient with End Stage Renal Disease: Results from a 72-Hour Fast.

Abraham A, Rubin M, Accili D, Bilezikian JP, Pajvani UB - Case Rep Endocrinol (2015)

Decline of C-peptide, insulin, and proinsulin observed during 72-hour fast.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664785&req=5

fig1: Decline of C-peptide, insulin, and proinsulin observed during 72-hour fast.
Mentions: During the 72-hour fast, insulin levels rapidly declined within 24 hours to normal; proinsulin and C-peptide levels fell in parallel but remained abnormally high (Table 1 and Figure 1). The patient completed the fast without developing further hypoglycemia or neuroglycopenic symptoms. The sulfonylurea screen, obtained at the time of admission, was positive for glipizide (performed by ARUP laboratories, positive at concentrations greater than 5 ng/mL). The patient and family denied inadvertent use of glipizide. The patient was discharged with new prescriptions in case there was a pharmacy error. When the patient returned for outpatient laboratory testing 1 week later, the repeated values were similar to those obtained at the end of the fast, with persistently elevated fasting C-peptide (8.8 ng/mL) and proinsulin (10.7 pmol/L) but normal insulin (14 μIU/mL) levels. He denied any recurrent hypoglycemia symptoms one week after hospital discharge. Furthermore, during subsequent admissions for worsening congestive heart failure, he exhibited no further signs or symptoms of hypoglycemia.

Bottom Line: Past medical history includes multiple myeloma, congestive heart failure, and hypertension.The sulfonylurea screen ultimately returned positive for glipizide, clinching the diagnosis.This is the first reported case which characterizes the chronic elevation of proinsulin in a patient with ESRD, as well as its dramatic increase after a presumed solitary exposure to sulfonylurea.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.

ABSTRACT
Insulin, proinsulin, and C-peptide levels increase with sulfonylurea exposure but the acuity of increase has not been described in dialysis patients. We present a case of a dialysis patient who presented with hypoglycemia and was found to have accidental sulfonylurea ingestion. This is a 73-year-old man with ESRD on peritoneal dialysis, without history of diabetes, who presented with hypoglycemia. Past medical history includes multiple myeloma, congestive heart failure, and hypertension. At initial presentation, his blood glucose was 47 mg/dL, with concomitant elevations in the following: C-peptide 30.5 (nl: 0.8-3.5 ng/mL), insulin 76 (nl: 3-19 μIU/mL), and proinsulin 83.3 (nl: ≤8.0 pmol/L). During the 72-hour fast, which he completed without hypoglycemia, insulin declined to be within normal limits (to 12 μIU/mL); proinsulin (to 12.1 pmol/L) and C-peptide (to 7.2 ng/mL) levels decreased but remained elevated. The sulfonylurea screen ultimately returned positive for glipizide, clinching the diagnosis. This is the first reported case which characterizes the chronic elevation of proinsulin in a patient with ESRD, as well as its dramatic increase after a presumed solitary exposure to sulfonylurea. The 72-hour fast conducted gives insight into the clearance of insulin, proinsulin, and C-peptide after sulfonylurea ingestion in ESRD.

No MeSH data available.


Related in: MedlinePlus