Glibenclamide (INN), also known as glyburide(USAN), is an antidiabetic drug in a class of medications known as sulfonylureas, closely related tosulfa drugs. It was developed in 1966 in a cooperative study between Boehringer Mannheim (now part of Roche) and Hoechst (now part of Sanofi-Aventis).[1]

It is sold in doses of 1.25 mg, 2.5 mg and 5 mg, under the trade names Diabeta, Glynase and Micronase in the United States and Daonil, Semi-Daonil and Euglucon in the United Kingdom and Delmide in India.

It is also sold in combination with metformin under the trade names Glucovance and Glibomet.

Glibenclamide (INN), also known as glyburide(USAN), is an antidiabetic drug in a class of medications known as sulfonylureas, closely related tosulfa drugs. It was developed in 1966 in a cooperative study between Boehringer Mannheim (now part of Roche) and Hoechst (now part of Sanofi-Aventis).[1]

It is sold in doses of 1.25 mg, 2.5 mg and 5 mg, under the trade names Diabeta, Glynase and Micronase in the United States and Daonil, Semi-Daonil and Euglucon in the United Kingdom and Delmide in India.

It is also sold in combination with metformin under the trade names Glucovance and Glibomet.

Oral hypoglycemic pills are a class of prescription medications used to control diabetes. Oral means "taken by mouth." There are many different types of oral hypoglycemics. This article focuses on a class called sulfonylureas.

An overdoseoccurs when someone accidentally or intentionally takes more than the normal or recommended amount of this medication.

This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.

Diabetes pill overdose; Sulfonylurea overdose

There are many types of oral hypoglycemics. The poisonous ingredient depends on the specific drug. The main (active) ingredient in sulfonylurea-based oral hypoglycemics stimulates cells in the pancreas to produce more insulin.

Sulfonylurea-based oral hypoglycemics are sold under a variety of brand names. Some are listed below.

• Acetohexamide (Dymelor)
• Chlorpropamide (Diabinese)
• Glipizide (Glucotrol)
• Glyburide (DiaBeta, Micronase)
• Glimepiride (Amaryl)
• Tolbutamide (Orinase)
• Tolazamide (Tolinase)

Note: This list may not be all-inclusive.

• Agitation
• Apathy (lack of desire to do anything)
• Coma
• Convulsions
• Confusion
• Increased appetite
• Nausea
• Nervousness
• Rapid heartbeat
• Stupor
• Sweating
• Tingling of tongue and lips
• Tremor

Determine the following information:

• Patient's age, weight, and condition
• Name of the product (ingredients and strengths, if known)
• Time it was swallowed
• Amount swallowed

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

See: Poison control center - emergency number

The health care provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. You may receive:

• Activated charcoal
• Blood tests to measure blood glucose
• Laxative
• Sugar solution given through a vein (IV)
• Tube through the nose into the stomach to empty the stomach (gastric lavage)

Some of these medications may stay in the body for a long time, so the individual need to be watched for several days. Death is possible, especially if an abnormal blood glucose level is not corrected in a timely manner.

Burns MJ, Levine M. Diabetic control agents. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 64.

Hypoglycemia is a condition that occurs when your blood sugar (glucose) is too low.

Blood sugar below 70 mg/dL is considered low. Blood sugars at this level can harm you.

Insulin shock; Low blood sugar

Hypoglycemia occurs when:

• Your body's sugar (glucose) is used up too quickly
• Glucose is released into the bloodstream too slowly
• Too much insulin is released into the bloodstream

Insulin is a hormone that reduces blood sugar. It is produced by the pancreas in response to increased glucose levels in the blood.

Hypoglycemia is relatively common in persons with diabetes. If you have diabetes and are taking any of the following diabetes medications, you have a risk for low blood sugar:

• Chlorpropamide (Diabinese), tolazamide (Tolinase), acetohexamide (Dymelor), glipizide (Glucotrol), or tolbutamide (Orinase)
• Glyburide (Micronase), glimepiride (Amaryl), repaglinide (Prandin), nateglinide (Starlix), and mitiglinide) -- the risk with these drugs is lower, but still possible
• Insulin

If you have diabetes, low blood sugars may occur when:

• You take too much insulin or diabetes medicine
• You don't eat enough food
• You suddenly increase your exercise without increasing the amount of food you eat

Relative hypoglycemia is a fairly common condition in which a newborn's blood sugar is low. Babies born to mothers with diabetes may have severe hypoglycemia.

Idiopathic hypoglycemia is hypoglycemia that occurs without a known cause. People with this type of hypoglycemia do not have diabetes.

Hypoglycemia may also be caused by:

• Ingestion of alcohol
• Insulinoma - a tumor in the pancreas that produces too much insulin
• Liver disease

Symptoms you may have when your blood sugar gets too low include:

• Cold sweats
• Convulsions
• Double visionor blurry vision
• Fast or pounding heartbeat
• General discomfort, uneasiness, or ill feeling (malaise)
• Headache
• Hunger
• Irritability (possible aggression)
• Nervousness
• Shaking or trembling
• Sleeping difficulty
• Tingling or numbness of the skin
• Tiredness or weakness
• Unclear thinking

Sometimes your blood sugar may be too low, even if you do not have symptoms. If your blood sugar gets too low, you may:

• Faint
• Have a seizure
• Go into a coma

Other symptoms that may occur with this disease:

• Decreased alertness
• Different size pupils
• Dizziness
• Hallucinations
• Memory loss
• Muscle pain
• Paleness

Home monitoring of blood sugar will show readings lower than 70 mg/dL.

Serum glucosetest will be low.

Treatment depends on the cause.

If you have diabetes, check your blood sugar level whenever you have symptoms of low blood sugar. If your blood sugar is low (70 mg/dL), you need to treat yourself right away.

Eat something that has about 15 grams of carbohydrates. Examples are:

• 3 glucose tablets
• A 1/2 cup (4 ounces) fruit juice or regular, non-diet soda
• 5 or 6 hard candies
• 1 tablespoon sugar, plain or dissolved in water
• 1 tablespoon honey or syrup

Wait about 15 minutes before eating any more. Be careful not to over-treat by eating too much. This can cause high blood sugar and weight gain.

Persons with severe hypoglycemia are treated with glucose injections or the hormone glucagon. Immediate treatment is needed to prevent serious complications or death.

Preventing low blood sugar is better than having to treat it. When you exercise, check your blood sugar levels. Make sure you have snacks with you if you take insulin or other medicines that lower your blood sugar.

Ask your doctor or nurse if you need a bedtime snack to prevent low blood sugar overnight. Protein snacks may be best. Do not drink alcohol without eating food. If you do drink, have only one or two drinks at the most.

Your doctor may tell you to change your diet so that you get more even amounts of glucose into your body throughout the day. You may be told to eat small, frequent meals with complex carbohydrates, fiber, and fat and to avoid simple sugars, alcohol, and fruit juice.

You should also eat meals at regular intervals, and balance extra exercise with extra food.

If hypoglycemia is caused by an insulinoma (insulin-secreting tumor), surgery to remove the tumor is the best treatment.

Untreated, hypoglycemia from too much insulin can lead to loss of consciousness and coma. Severe hypoglycemia is a medical emergency that may result in seizures and permanent damage to the nervous system if not treated. Severe hypoglycemia that results in unconsciousness is also called insulin shock.

Learn to recognize the early warning signs of hypoglycemia and treat yourself quickly and appropriately.

Go to the emergency room immediately or call a local emergency number (such as 911) if early signs of hypoglycemia do not improve after you've eaten a snack containing sugar.

Get immediate medical help if a person with diabetes or a history of hypoglycemia loses alertness or if you can't wake them up.

If you have diabetes, make sure you follow your doctor's advice regarding diet, medications, and exercise.

If you have a history of hypoglycemia, you should keep a snack or drink containing sugar available at all times to take as soon as symptoms appear. If symptoms do not improve in 15 minutes, eat more food. A glucagon kit is available for those who have episodes of hypoglycemia that don't respond well to other types of treatment.

Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care. 2003; 26(6): 1902-1912.

American Diabetes Association. Standards of medical care in diabetes--2010. Diabetes Care. 2010;33 Supl 1:S11-S61.