Pentamidine

An anti-parasitic agent used to treat infections with Pnemocystis carinii (107). It is well known for causing hypoglycemia, IGT and overt DM (108). Diabetes has been observed in more than 100 patients, sometimes with ketoacidosis or lactic acidosis (109-114). Hypoglycemia and diabetes have also been reported after pentamidine isethionate (115) and pentamidine aerosol therapies (116,117). Inappropriate plasma insulin levels were sometimes determined: they were excessive in the presence of hypoglycemia, and lower than normal in the diabetic patients treated with pentamidine (110). It has been suggested that a dose-dependent toxicity of pentamidine to the islets of Langerhans can account for these opposite adverse metabolic effects: an early excessive insulin leakage from lesioned B-cells as a cause of hypoglycemia, and then B-cell death and insulinopenia causing diabetes.

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