Boglou Panagiotis, Steiropoulos Paschalis, Papanas Nikolaos, Bouros Demosthenes
Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece.
BMJ Case Rep. 2013 Apr 16;2013:bcr2012008528. doi: 10.1136/bcr-2012-008528.
Hypoglycaemia is a well-recognised untoward effect of sulfonylureas. We report a case of severe hypoglycaemia after isoniazid initiation in a type 2 diabetic patient. An oral glucose tolerance test revealed high serum insulin and C peptide, suggesting hyperinsulinaemia, and it was used to ascertain the relationship between insulin, glucose and C peptide levels. Insulin and C peptide elevation was attributed to the interaction between the two drugs. As a cytochrome inhibitor, isoniazid increased serum glimepiride concentration, resulting in hyperinsulinaemia. The diagnosis of occult insulinoma or nesidioblastosis was ruled out by CT and MRI, as we could not perform more sensitive, still invasive, diagnostic procedures. After isoniazid withdrawal, hypoglycaemia regressed and glimepiride was reinitiated. In conclusion, this case illustrates the need of caution when prescribing isoniazid in patients with type 2 diabetes mellitus receiving glimepiride to avoid hypoglycaemia.
低血糖是磺脲类药物一种广为人知的不良反应。我们报告一例2型糖尿病患者在开始使用异烟肼后发生严重低血糖的病例。口服葡萄糖耐量试验显示血清胰岛素和C肽水平升高，提示高胰岛素血症，该试验用于确定胰岛素、葡萄糖和C肽水平之间的关系。胰岛素和C肽水平升高归因于两种药物之间的相互作用。作为一种细胞色素抑制剂，异烟肼增加了血清格列美脲浓度，导致高胰岛素血症。由于无法进行更敏感但仍具侵入性的诊断程序，CT和MRI排除了隐匿性胰岛素瘤或胰岛细胞增生症的诊断。停用异烟肼后，低血糖症状消退，格列美脲重新开始使用。总之，该病例表明，在给正在接受格列美脲治疗的2型糖尿病患者开异烟肼时需要谨慎，以避免低血糖。
