A 26-year-old nurse presents with recurrent early-morning hypoglycaemia and confusion. During a supervised episode, glucose is 38 mg/dL with insulin 42 µU/mL and C-peptide 6.2 ng/mL (both inappropriately high), and a specific serum assay detects glimepiride. After acute correction with dextrose, hypoglycaemia recurs repeatedly. Which agent best prevents recurrent episodes while the drug clears?
- A Diazoxide
- B Nifedipine
- C Octreotide ✓
- D Glucagon infusion
Correct answer: C. Octreotide
Explanation
Sulfonylurea ingestion, whether accidental or factitious, closes pancreatic KATP channels, driving insulin release with matched high B-peptide. Octreotide, a somatostatin analogue, suppresses insulin secretion and is the preferred adjunct to dextrose for refractory sulfonylurea-induced hypoglycaemia. Diazoxide opens KATP channels and is used in congenital hyperinsulinism, whereas glucagon mobilises hepatic glycogen only transiently and does not block ongoing insulin release.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
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