Severe and Prolonged Hypoglycemia Associated with Glibenclamide Use in a Geriatric Patient with Chronic Kidney Disease: A Case Report

Abstract

Introduction: Glibenclamide (glyburide) is a second-generation sulfonylurea widely used to treat type 2 diabetes because of its low cost and potent glucose-lowering effect; however, its renally eliminated active metabolites make it a high-risk drug for severe hypoglycemia, particularly in older adults and in those with chronic kidney disease. Case presentation: We report the case of a 78-year-old man with a 15-year history of type 2 diabetes and hypertension, treated with glibenclamide 5 mg every 12 hours, who was admitted in a comatose state (Glasgow Coma Scale 6) after skipping dinner but taking his usual nighttime dose. Capillary glucose on admission was 32 mg/dL. Work-up revealed acute kidney injury superimposed on chronic kidney disease, explaining drug accumulation and recurrent hypoglycemia despite initial dextrose boluses. He was managed with continuous 10 % dextrose infusion, permanent discontinuation of glibenclamide, and intravenous hydration, with full recovery within 5 days. Conclusions: This case illustrates the preventable risk of severe, prolonged hypoglycemia associated with glibenclamide in geriatric patients with chronic kidney disease, and underscores the need to avoid long-acting sulfonylureas in this population, individualize HbA1c targets, and prioritize agents with lower hypoglycemic risk and cardiorenal benefit, such as SGLT2 inhibitors, dose-adjusted metformin, or DPP-4 inhibitors.