SAT-553 Methadone Induced Hypoglycemia

Abstract Disclosure: D. Karanam: None. V. Thudi: None. S. Bantu: None. B. Jakka: None. Introduction: Hypoglycemia is a known complication in patients taking glucose lowering medications. It is a less encountered problem in non-diabetic patients. The etiology for hypoglycemia in this population includes- drugs, critical illness, hormone deficiency, non-islet cell tumor, endogenous hyperinsulinemia and malicious hypoglycemia. We report a patient of Methadone induced hypoglycemia with a history of Gastric bypass surgery. Case Presentation: A 39-year-old Caucasian female presented to ED with abdominal pain, nausea and loss of appetite. She has a known history of polysubstance abuse, cholecystectomy, gastric sleeve bypass surgery done 10 yrs ago. Patient reported recent visits to the ER for hypoglycemia with lowest serum glucose being 33 Physical exam was unremarkable. Home medications include Methadone 460 mg daily for chronic back pain. Lab workup was normal except for a serum glucose level of 66 mg/dl and positive UDS. CT abdomen & pelvis showed no acute findings. Initially, she was started on 5% dextrose drip and then added Octreotide 100 mg TID due to persisting hypoglycemia. 1 week later, Methadone was discontinued, and Endocrinology was consulted for further evaluation. As per our recommendations, dextrose and octreotide was stopped. Patient was placed NPO with frequent glucose checks. 1 day later, the POC glucose was 65 with concomitant serum glucose of 60. During this hypoglycemic episode Insulin, Pro insulin, C-peptide, sulfonylurea levels were drawn and noted with high Insulin-11.2 uIU/ml. Patient’s hypoglycemic episodes resolved after 5 days of Methadone discontinuation. She was transitioned to buprenorphine to manage the opioid dependency syndrome. Discussion: Methadone is most commonly used in the treatment of opioid dependency syndrome because of its efficacy in treating all levels of dependence. Methadone more than other opioids can cause hypoglycemia in predisposed individuals. This is a dose dependent response especially above 40 mg per day orally. The mechanism of action is unclear but multiple mechanisms are described in literature. It can cause hypoglycemia by direct action on pancreas (mu opioid receptors) which increases insulin levels along with suppressing counter regulatory hormones like glucagon and epinephrine. However, further research in this area is warranted. In our patient, the insulin levels were not suppressed during the hypoglycemic episode. Further supporting the hypothesis, patient did not have any more hypoglycemia episodes after discontinuing the Methadone. Conclusion: Methadone is a rare cause of hypoglycemia. It has a dose dependent effect and due to long half-life, can cause recurrent episodes of hypoglycemia. Therefore, clinicians should be vigilant of this potential complication. Presentation: Saturday, July 12, 2025