Phenytoin, known to cause hyperglycemia in diabetic and non-diabetic patients, was chronically administered to a chlorpropamide-controlled diabetic patient. Admitted to the hospital with a blood glucose of 461 mg/dL and a β-ketone level of 113 mg/dL, the patient's condition could not be controlled with increasing daily dosages of NPH insulin and regular insulin coverage. Within five days of discontinuing the phenytoin, the blood sugars began to decline, leading to decreasing insulin requirements. Prior to discharge, the patient was changed from insulin to chlorpropamide. Follow-up during subsequent clinic visits has revealed well-controlled blood sugar levels.
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References
1.
VictorMBrauschJ.The role of abstinence in the genesis of alcoholic epilepsy. Epilepsia1967; 8: 1–20.
2.
KaimSCKlettCJRothfieldB.Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Am J Psychiatry1969; 125: 1640–6.
3.
GolbertTMSanzCJRoseHDComparative evaluation of treatments of alcohol withdrawal syndromes. JAMA1967; 201: 99–102.
4.
SamplinerRIberFL.Diphenylhydantoin control of alcohol withdrawal seizures: results of a controlled study. JAMA1974; 230: 1430–2.
5.
Koch-WeserJ.Alcohol intoxication and withdrawal. N Engl J Med1976; 294: 757–62.
6.
MillichapJG.Hyperglycemia effect of diphenylhydantoin (letter). N Engl J Med1969; 281: 447.
7.
SanbarSSConwayFJZweiflerAJSmetG.Diabetogenic effect of DilantinrG (diphenylhydantoin) (abstr). Diabetes1967; 16: 533.
8.
LevinSRGrodskyGMHaguraRSmithD.Comparison of the inhibitory effects of diphenylhydantoin and diazoxide upon insulin secretion from the isolated perfused pancreas. Diabetes1972; 21: 856–62.
9.
GoldbergEMSanbarSS.Hyperglycemia, nonketotic coma following administration of DilantinrG (diphenylhydantoin). Diabetes1969; 18: 101–6.
10.
KleinJP.Diphenylhydantoin intoxication associated with hyperglycemia. J Pediatr1966; 69: 463–5.
11.
PetersBHSamaanNA.Hyperglycemia with relative hypoinsulinemia in diphenylhydantoin toxicity. N Engl J Med1969; 281: 91–2.
12.
MalherbeCBurrillKCLevinSRKaramJHForshamPH.Effect of diphenylhydantoin on insulin secretion in man. N Engl J Med1972; 286: 339–42.
13.
FarissBLLuthcerCL.Diphenylhydantoin-induced hyperglycemia and impaired insulin release. Diabetes1971; 20: 177–81.
14.
LevinSRBookerJSmithDFGrodskyGM.Inhibition of insulin secretion by diphenylhydantoin in the isolated perfused pancreas. J Clin Endocrinol Metab1970; 30: 400–1.
15.
HvidbergEFDannM.Clinical pharmacokinetics of anticonvulsants. Clin Pharmacokinet1976; 1: 161–88.
16.
EnsinckJWStollRWGaleCGEffect of aminophylline on the secretion of insulin, glucagon, luteinizing hormone and growth hormone in humans. J Clin Endocrinol Metab1970; 31: 153–61.
17.
KoelleGB.Neurohumoral transmission and the autonomic nervous system. In: GoodmanLSGilmanA eds. The pharmacological basis of therapeutics. 5th ed.New York: Macmillan, 1975: 429.
