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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...

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Updated: Jun 26, 2026

Hyperglycemic Clamp and Hypoglycemic Clamp in Conscious Mice

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Published on: January 26, 2024

Hypoglycemia in a healthy toddler.

Miguel Glatstein¹, Facundo Garcia-Bournissen, Dennis Scolnik

¹Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada.

Therapeutic Drug Monitoring

|January 15, 2009

Summary

Sulfonylurea ingestion is a serious threat to toddlers, causing prolonged hypoglycemia. This case highlights Munchausen-by-proxy syndrome as a cause of non-accidental sulfonylurea poisoning in a child.

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Area of Science:

Pediatric Toxicology
Endocrinology
Child Abuse and Neglect

Background:

Sulfonylureas are potent oral hypoglycemic agents used in type 2 diabetes.
Accidental or intentional ingestion in toddlers can lead to severe, prolonged hypoglycemia.
The

Observation:

An 18-month-old girl presented with altered mental status and severe hypoglycemia requiring intensive glucose management.
Family history of type 2 diabetes led to testing for sulfonylureas.
Serum analysis confirmed sulfonylurea presence, indicating intentional ingestion.

Findings:

The child's hypoglycemia was attributed to non-accidental sulfonylurea ingestion.
Investigation revealed the mother's Munchausen-by-proxy syndrome as the cause.
Over 20% of reported sulfonylurea poisonings involve abuse or homicide attempts.

Implications:

Clinicians should consider sulfonylurea intoxication in unexplained pediatric hypoglycemia.
Suspected child abuse or neglect requires careful evaluation in such cases.
Management involves glucose infusion, avoiding boluses to prevent rebound hyperinsulinism.