Oral Diabetes Medication Toxicity

Intro/Background

Type II Diabetes (T2D) is a common disease – in Indiana about 675,000 individuals (13% of the residents) have it. It can often be managed with careful attention to diet, exercise, and the use of oral medications. The most common medications used for initial treatment of T2D are metformin and a class of drugs called sulfonylureas. Exposure to the medications used to treat T2D account for about 8% (356 cases) of the exposure cases reported annually to Indiana Poison Center. Management of these exposures can become complicated.

Sulfonylureas treat hyperglycemia (high blood sugar) by stimulating the production of more insulin from pancreatic beta-islet cells. For people with high blood sugar, like those with diabetes, use of a sulfonylurea causes their blood glucose to drop to the normal range. If the person does not have hyperglycemia, a sulfonylurea may cause a symptomatic, potentially life-threatening hypoglycemia (low blood sugar). These symptoms may not become obvious for up to 12 to 24 hours after ingestion, and the hypoglycemia may persist for up to 72 hours afterwards.

Exposure to as little as one tablet of a sulfonylurea medication such as glipizide or glimepiride (Glucotrol or Amaryl) can cause a severe drop in the blood sugar level (hypoglycemia). If a person does not have the disease diabetes mellitus, which causes high blood sugar, that hypoglycemia can cause serious or even life-threatening symptoms.

Since the consequences can be so devastating and since the onset of hypoglycemia can be so delayed, children and naive adults (those who are not currently taking the medication) who have taken even one tablet of a sulfonylurea class medication must be referred to the hospital.

How Can I Prevent Poisonings from Happening?

• ALWAYS keep your medications in the original, labeled bottle with the CRC (child-resistant cap) in place.
• NEVER mix pills in one container!
  • Don’t put more than one type of pills in one container.
  • Don’t put the remainder of the old prescription in with the new prescription.
• Child-resistant does not mean “Child-proof”!  NOTHING IS CHILD-PROOF!
• If you can possibly avoid it, don’t use the daily pill boxes – they are not child-resistant.
• Purses, briefcases, backpacks and suitcases are all “little children magnets”.  Children love to look in your bags – that is where the candy & the presents are!  So, when you travel, don’t leave your medicines in your purse, briefcase or suitcase.
• When you visit homes with young children or have young children visit you – have a safe place to lock away your medications and dangerous items.  High and out-of-sight is best! If visiting, check with your host and identify a place you can keep your medications that is high and out-of-sight.  Ideally it will be a locked cabinet.
• Never put medications or chemicals into anything other than their original container.
• Never store medications or chemicals near food – do not put them in the pantry or the refrigerator.

Symptoms of Oral Diabetes Medication Exposure​

At first the patient may experience:

• Slight anxiety, shakiness, sleepiness
• Become nauseated
• Their skin may become pale, cool and clammy

These symptoms can quickly to progress to symptoms that make the patient “look drunk”:

• They can’t walk straight
• Confusion
• Slurred Speech
• Vomiting

Eventually they appear to fall asleep, lose consciousness, and if they don’t receive appropriate treatment, they may die.

If you think an exposure has happened, bring the product and the child to the phone and call Indiana Poison Center at 1-800-222-1222.