Quantitative insulin and C-peptide levels among ED patients with sulfonylurea-induced hypoglycemia-a prospective case series.
OBJECTIVE
The objective of this study was to measure the serum insulin and C-peptide concentrations among diabetic patients known to be taking sulfonylurea agents who presented to the emergency department with hypoglycemia thought to be due to therapeutic usage as opposed to overdose. A recently published systematic review of 22 articles involving 76 patients with sulfonylurea-induced hypoglycemia (glucose <49 mg/dL) resulting from accidental ingestion or intentional overdose found that patients had an average serum insulin concentration of 3.9 μIU/mL or higher and an average serum C-peptide concentration of 1.4 ng/mL or higher.


METHODS
This is a prospective cross-sectional descriptive case series.


RESULTS
Thirteen of 14 study subjects had initial insulin and C-peptide levels consistent with the diagnosis of sulfonylurea-induced hypoglycemia as previously defined among patients presenting after overdose.


CONCLUSIONS
Patients presenting with hypoglycemia resulting from therapeutic sulfonylurea use demonstrate similar insulin and C-peptide levels as has previously been published among patients who presented with presumed overdose.
Fasano
Charles J
CJ
Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA. fasanoc@einstein.edu
Rowden
Adam K
AK
O'Malley
Gerald F
GF
Aguilera
Elizabeth
E
Heard
Kennon
K
D000368:Aged; D000369:Aged, 80 and over; D002096:C-Peptide / Q000097:blood*; D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000097:blood; D005260:Female; D005913:Glipizide / Q000009:adverse effects; D005905:Glyburide / Q000009:adverse effects; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013453:Sulfonylurea Compounds / Q000009:adverse effects*
D002096:C-Peptide; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D005905:Glyburide; D005913:Glipizide