A Possible Case of Opioid-Induced Hypoglycemia and the Potential Role of Naloxone

Literature has found that individuals with opioid use disorders have increased fasting insulin levels and that antagonism of the μ-receptor with naloxone blunted this hypoglycemic effect. We describe a 35-year-old woman with no history of diabetes who presented after being found unconscious where she was given naloxone and became awake and combative. Her blood glucose (BG) on presentation was 175 mg/dl, which declined to 40 mg/dl, and dextrose was administered. Subsequently, it declined to 42 mg/dl and was again given dextrose. Later her BG fell to 67 mg/dl and she was given dextrose and started on a dextrose infusion. She was then administered IV naloxone and 1 hr later the infusion was discontinued and she had no further hypoglycemic events. Clinicians should consider altering monitoring parameters in the setting of acute overdoses to include repeated glucose assessment to ensure early identification of hypoglycemia and the potential influence of naloxone.