Abstract

*Nallani Sai Pradeep and Unnam Vamsi Krishna

ABSTRACT

Sulfonylureas are commonly used medications in diabetes due to their lower cost. However, Sulfonylureas use is associated with severe hypoglycemia. Here is a case of 74 year old female with type 2 diabetes mellitus who was taking regular doses of glyburide 5mg daily and metformin 1000mg twice daily. She presented to emergency department after her family noticed acute onset of confusion, disorientation, and unresponsiveness, with an initial blood glucose reading of 45mg/dl. She appeared pale, was excessively sweating and had a slow heart rate. She had chronic type 2 diabetes mellitus, poorly controlled for the last 6 months. Her serum creatinine was increased to 3mg/dl from a baseline value of 0.9 mg/dl measured 2 weeks before admission. The patient had no signs of infection, trauma, or other acute illness and was diagnosed as severe hypoglycemia due to Sulfonylurea overdose. Immediately intravenous dextrose infusion was started with 50ml of 50% dextrose. The patient was closely monitored in ICU with frequent blood glucose levels measurements. According to beers criteria, sulfonylureas are usually avoided in geriatric diabetic patients with renal or hepatic dysfunction due to the increased risk of severe hypoglycemia. After stabilization sulfonylurea medication (glyburide) was stopped and patient’s diabetes regimen was modified to a lower dose of insulin therapy to avoid further hypoglycemic episodes.