第2 型糖尿病儘管已經發展出多種治療藥物，然而胰島素製劑與磺胺脲素劑仍然被廣泛 應用於第2 型糖尿病患。前兩者是引起第2 型糖尿病的嚴重低血糖症的主要藥物。第2 型糖尿 病患發生嚴重低血糖症時，在專業醫療機構依目前指引處置時，大致上與第1 型糖尿病患的 低血糖症處置相同。一般緊急治療處置嚴重低血糖症可以使用升糖素(glucagon) ( 可由專業人 員或經充分衛教後之親朋使用)、或者用葡萄糖溶液( 範圍從5%到50%)靜脈注射( 推注或連續 輸注)。這仍然是臨床上最廣泛使用的標準治療。臨床上，藉著升糖素快速的肝醣分解作用， 以作為嚴重低血糖症的緊急處置處方，求得一時性緩解低血糖症。然而在第2 型糖尿病，升 糖素可以經由刺激β細胞進一步釋放胰島素，繼而導致反覆性後續降低血糖的作用。葡萄糖 的供給若只是間歇性的、或是不充分的，血糖上下劇烈振動就可能發生，所以連續輸注是較 妥當的作法。然而第2 型糖尿病患常併腎功能或心臟功能不足之共病症，連續輸注也可能出 現流體過載，造成心臟衰竭。這些限制也是葡萄糖溶液連續輸注治療時應注意的事項。第2 型糖尿病之嚴重低血糖使用除了升糖素治療與葡萄糖溶液外，尋求一有效地修正潛在的病理 機制的治療確實有其必要性。Octreotide為一種人工合成之體抑素(somatostatin)類似物。它結 合體抑素受體，並抑制胰島β細胞而極度減少胰島素的分泌。Octreotide用於治療磺胺脲素劑 導致嚴重低血糖症時，兼顧連續輸注可能導致流體過載與病理性胰島素釋放之導正。從最近 的個案報導、系統資料回溯研究、與前瞻性隨機雙盲的研究，octreotide似乎是一個治療磺胺 脲素劑引發嚴重低血糖症有效和安全的選項。

Hypoglycemia is a common problem in the treatment of diabetes mellitus. Insulin preparations and sulfonylurea are widely used in treatment of type 2 diabetes mellitus. Both are the main causes of severe hypoglycemia in the treatment of patients with type 2 diabetes. For severe hypoglycemia in type 2 diabetes, the treatment guidelines are similar to those with hypoglycemia in type 1 diabetes. Glucagon or glucose solution (ranging from 5% to 50%) intravenous (bolus or continuous infusion) are widely used in the general emergency treatment for severe hypoglycemia. Glucagon with the fast action of glycolysis is used for emergency treatment of severe hypoglycemia to get temporary remission of hypoglycemia. However, unlike type 1 diabetes, the β cells in patients with type 2 diabetes are hyperactive under action of sulfonylurea. Glucagon, despite of its hyperglycemic effect by glycolysis, can further release of insulin via stimulation of β cells, and then lead to subsequent paradoxical hypoglycemia. If the glucose supply is intermittent, or insufficient, the concentration of blood glucose may highly fluctuate, so that glucose solution continuous infusion is suggested. However, comorbidities of renal or cardiac insufficiency in patients with type 2 diabetes frequently limit the continuous glucose infusion therapy which may result in fluid overload. In addition to the current glucagon and continuous glucose infusion therapies, a medicine which can fix the underlying pathological mechanism is desirable to get an adequate treatment for severe hypoglycemia in type 2 diabetes. Octreotide is a synthetic somatostatin analog. Through action on somatostatin receptors, octreotide can inhibit β cells of islets and extremely reduce the secretion of insulin. As the hazards of fluid overload and rebound hypoglycemia in the current therapy, octreotide may pathophysiologically play a role in the treatment of sulfonylurea-induced severe hypoglycemia. From the recent case reports, retrospective study information systems, and prospective randomized double-blind, octreotide therapy seems to be a safe option for sulfonylurea-induced severe hypoglycemia. (J Intern Med Taiwan 2015; 26: 162-168)