SUN-184 Sertraline-Induced Hypoglycemia in Nondiabetic Patients

Background SSRI’s are effective for treatment of depressive disorders by reducing serotonergic function and hence altering neuroendocrine function. The effects of sertraline on blood glucose in non-diabetic patients was demonstrated in this case. Case 39 year-old African-American female with a medical history of GERD, hypertension, marijuana abuse, and panic attacks on trazadone presented with tremors, insomnia, and diaphoresis. Her symptoms began two days after she started sertraline. Physical examination and EKG were unremarkable. Initial blood glucose was 56. Laboratory results indicated HbA1C 4.5%(4.8 – 6.0%), beta-hydroxybutyrate 0.6mmol/L(0.02 – 0.27mmol/L), TSH 0.81uIU/ml(0.27 – 4.62uIU/mL), and insulin 20.8uU/mL(2.6 – 24.9uU/mL). Her sulfonylurea screen and urine toxicology were negative. UA was positive for glucose and ketones. She discontinued sertraline and was given glucose supplements which improved glucose to 226 and she had a full recovery. Discussion We believe this was SSRI-induced hypoglycemia because of her recent introduction of sertraline. WHO reports more than 440 cases annually of SSRI-induced hypoglycemia and over 100 with sertraline.(2) One way SSRI’s increase risk of hypoglycemia is by impairing hormonal counter-regulatory response (CRR) of epinephrine and glucagon.(3) Sertraline induces linear pharmacokinetics with changes in drug concentration in proportion to change in dose through inhibition of neuronal reuptake of serotonin (5-HT). Study by Sanders et al. found sertraline treatment lasting longer than 6-20 days resulted in increased epinephrine and restored the blunted adreno-medullary response seen in acute administration.(3) Another way sertraline can induce hypoglycemia is by regulation of liver receptors through 5-hydroxytryptamine activation and inhibition of potassium channels, resulting in increased insulin sensitivity and production and reduced gluconeogenesis. Study by Gomez et al. showed rats pre-medicated with sertraline neutralized hyperglycemia post-glucose load(1) indicating that symptoms can resolve with discontinuation of sertraline and glucose supplementation. Conclusion and Follow-Up Results Sertraline-induced hypoglycemia is becoming more prevalent in non-diabetic patients. Correction of sertraline-induced hypoglycemia by discontinuing the medication and adding glucose can resolve hypoglycemia and the associated side-effects. References(1)Gomez R. Acute effect of different antidepressants on glycemia in diabetic and non-diabetic rats. Braz J Med Biol Res. 2001;34:57–64. (2)Khoza S. Glucose dysregulation associated with antidepressant agents: an analysis of 17 published case reports. IJCP. 2011;33:484–492. (3)Sanders N. The selective serotonin reuptake inhibitor sertraline enhances counterregulatory responses to hypoglycemia. AJP: Endocrinology and metabolism. 2008;294(5):E853-60.