title: Quantitative insulin and C-peptide levels among ED patients with sulfonylurea-induced hypoglycemia-a prospective case series.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA. fasanoc@einstein.edu
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Fasano
authors.forename: Adam K
authors.initials: AK
authors.lastname: Rowden
authors.forename: Gerald F
authors.initials: GF
authors.lastname: O'Malley
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Aguilera
authors.forename: Kennon
authors.initials: K
authors.lastname: Heard
mesh_terms: 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*
chemical_list: D002096:C-Peptide; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D005905:Glyburide; D005913:Glipizide