At the recent gathering of the American Association of Clinical Endocrinology meeting, a provider shared a surprising case study of life-threatening hypoglycemia in a 33-year-old without diabetes.
Unknowingly, this individual thought they were purchasing “street Valium”, but was sold the potent sulfonylurea, glyburide, instead. As a result, their blood sugar dropped to 18 mg/dL, causing unconsciousness and the need for emergent medical assistance. This individual had purchased two unmarked, light blue pills on the street, which they thought were Valiums but turned out to be glyburide. Since sulfonylureas aren’t detected in urine toxicology screens, the symptoms of hypoglycemia may be mistakenly attributed to other causes or drugs. The only way to detect the presence of sulfonylureas is through blood tests.
“Physicians should be aware of this possibility and consider intentional or unintentional sulfonylurea abuse, with or without other drugs,” Amanda McKenna, MD, a first-year endocrinology fellow at the Mayo Clinic, Jacksonville, Florida, and colleagues say in a poster presented at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2023.
Glyburide has a similar appearance to street valium. It is cheaper and easier to acquire than Valium (a controlled substance) which explains its appearance in illicit drug sales over the past two decades. However, since glyburide stimulates sustained insulin secretion, consumption can lead to life-threatening prolonged hypoglycemia. In addition, the person consuming it may attribute their symptoms to the “Valium” they thought they were taking and is vulnerable to severe hypoglycemia.
If hypoglycemia is detected, D50W is commonly used to immediately raise glucose levels. But, since sulfonylurea has a long half-life, blood sugars may plummet again. The most effective treatment to sustain blood sugars for those with glyburide toxicity is the administration of octreotide. Octreotide, a long-acting somatostatin agonist, reverses the insulin-releasing effect of sulfonylureas on pancreatic beta cells, resulting in diminished insulin secretion.
Cases like these have been reported for the past two decades. But how many incidents are we missing? Sharing this information with first responders, emergency department staff, and our communities can save lives.
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