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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
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Severe Hypoglycemia Caused by Lenalidomide.

Daniel J Przybylski1,2, Ruemu Birhiray3, David J Reeves1,2

  • 1College of Pharmacy and Health Sciences, Butler University, Indianapolis, Indiana.

Pharmacotherapy
|November 21, 2017
PubMed
Summary

Lenalidomide, used for multiple myeloma, may cause severe hypoglycemia. This case report details a patient experiencing grade 3 hypoglycemia, resolving upon drug discontinuation, highlighting a rare but serious adverse effect.

Keywords:
hypoglycemialenalidomidemultiple myeloma

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Area of Science:

  • Endocrinology
  • Oncology
  • Pharmacology

Background:

  • Lenalidomide is a standard treatment for multiple myeloma.
  • Adverse effects are known, but severe hypoglycemia is rarely reported.
  • Previous reports noted only mild hypoglycemia in solid tumor trials.

Observation:

  • A 74-year-old woman with refractory myeloma and type 2 diabetes developed severe hypoglycemia (grade 3) after lenalidomide maintenance therapy.
  • Hypoglycemia persisted despite stopping diabetes medications and resolved upon lenalidomide withdrawal.
  • Symptoms recurred upon lenalidomide re-challenge, suggesting a causal link.

Findings:

  • The Naranjo scale confirmed a definite relationship (score 9) between lenalidomide and grade 3 hypoglycemia.
  • This is the first reported case of severe (grade 3) hypoglycemia attributed to lenalidomide.
  • The patient's glucose levels normalized after lenalidomide discontinuation.

Implications:

  • Clinicians should monitor for hypoglycemia in patients receiving lenalidomide, especially those with diabetes.
  • This case expands the known adverse effect profile of lenalidomide.
  • Further investigation into lenalidomide-induced hypoglycemia is warranted.