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Case report
A case of severe relapsing sulphonylurea-induced hypoglycaemia
  1. Simon Mifsud1,
  2. Emma Louise Schembri2 and
  3. Stephen Fava1
  1. 1 Department of Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta
  2. 2 Department of Medicine, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Simon Mifsud; mifsudsimon{at}


The authors report a case of a 64-year-old woman who was diagnosed with severe relapsing sulphonylurea-induced hypoglycaemia. Sulphonylureas are frequently used in patients with type 2 diabetes mellitus. They promote insulin secretion independent of the prevailing glucose level and thus are associated with an increased risk of hypoglycaemia. In patients with adequate renal function, gliclazide’s effect lasts 10–24 hours and it is usually completely eliminated within 144 hours postdose. Since our patient suffered from chronic kidney disease, gliclazide’s effect was prolonged and she was experiencing spontaneous hypoglycaemic episodes up to 21 days postomission of gliclazide. This case highlights two important aspects. Primarily, the prolonged effect of sulphonylureas in patients with impaired renal function, hence highlighting the need to be cautious prior to prescribing sulphonylureas in such patients. Secondly, the importance of prolonged observation of patients on sulphonylureas even after the initial hypoglycaemic event is corrected, due to the extended effects of such drugs.

  • endocrine system
  • diabetes
  • endocrinology

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  • Contributors SM and ELS were responsible for literature review and manuscript preparation. SF contributed towards editing and review of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.