FACT : Methadone, a synthetic, long acting opioid can cause symptomatic hypoglycemia in patients.

GIVE ME THE DEETS:

Methadone causes glycemic dysregulation
Methadone maintenance patients have blunted prolactin responses to insulin-induced hypoglycemia.
Delayed and inhibited insulin responses to food ingestion have been demonstrated in methadone maintenance patients.
Only the l-isomer of methadone causes hypoglycemia while the d-isomer does not.
Commercially available methadone is a racemic mixture of the l and d isomers.
Mouse models have demonstrated that the hypoglycemia can occur one hour after methadone ingestion.
The hypoglycemic effects of methadone are reversed by naloxone and mu selective antagonists β-funaltrexamine and naloxonazine.
Propoxyphene, an opioid drug structurally related to methadone, causes hypoglycemia, especially in patients with renal failure.

RECOMMENDATIONS:

1. Educate all patients about the risk of hypoglycemia when starting them on methadone.

2. Watch for unexplained sweating, palpitations, or lethargy in patients on methadone.