UMEM Educational Pearls

Category: Toxicology

Title: Which Antidiabetics are Likely to Cause Hypoglycemia in Overdose?

Keywords: hypoglycemia, overdose, diabetes, antidiabetic (PubMed Search)

Posted: 9/10/2013 by Bryan Hayes, PharmD (Emailed: 9/12/2013) (Updated: 9/12/2013)
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With several new diabetes medications available, it is important to know which ones are likely to cause hypoglycemia after overdose. Based on mechanism of action and reported cases, the likelihood of hypoglycemia after overdose is listed below by drug class.

Keep in mind that other drugs can interact with antidiabetics resulting in hypoglycemia. This table applies only to single agent ingestion/administration.

Drug Class Examples Hypoglycemic Potential
Insulins Glargine, Aspart, Detemir High
Sulfonylureas Glyburide, Glipizide High
Meglitinides Nateglinide, Repaglinide High
Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Exenatide Low-Moderate
Alpha-glucosidase inhibitors Acarbose, Miglitol Low
Thiazolidinediones Rosiglitazone, Piaglitazone Low
Biguanides Metformin Low
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors Sitagliptin, Saxagliptin Low



Bosse GM. Chapter 48. Antidiabetics and Hypoglycemics. In: Bosse GM, ed. Goldfrank's Toxicologic Emergencies. 9th ed. New York: McGraw-Hill; 2011. Accessed September 10, 2013.

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