International Journal of Clinical Pharmacy

, Volume 41, Issue 1, pp 3–5 | Cite as

Abuse of sulfonylureas: Is factitious hypoglycemia a cause for concern?

  • Mayyada WazaifyEmail author
  • Leen Abushams
  • Marie Claire Van Hout


Several prescription and nonprescription drugs are liable for abuse. However, oral hypoglycemic agents are among the most benign and low-risk drugs in terms of abuse liability. This commentary intends to raise awareness regarding the abuse of a particular type of oral hypoglycemic agent, namely sulfonylurea drugs, used to experience mental-altering effects for its euphoric “hypoglycemic rush.” Information is available on discussion fora online where people exchange their experiences. Moreover, several case reports have been published and described the liability for abuse of sulfonylurea drugs. This article intends to shed the light on this phenomenon in light of the available literature, attempting to explain the possible scientific basis for it. In addition, it highlights the need for health professional awareness and vigilance for this form of drug diversion.


Abuse Euphoria Factitious hypoglycemia Prescription drug abuse Sulfonylurea 




Conflicts of interest



  1. 1.
    Suusman KE. The use and abuse of oral hypoglycemic agents. Rocky Mt Med J. 1967;64(2):56–9.Google Scholar
  2. 2.
    Horwitz DL. Factitious and artifactual hypoglycemia. Endocrinol Metab Clin N Am. 1989;18(1):203–10.CrossRefGoogle Scholar
  3. 3.
    Brown A. Feeling euphoric on a low-carb diet? The effect on your brain is similar to an illicit drug. The conversation website. 2017. Accessed 2 July 2018.
  4. 4.
    Hughes GF, McElnay JC, Hughes CM, McKenna P. Abuse/misuse of non-prescription drugs. Pharm World Sci. 1999;21:251–5.CrossRefGoogle Scholar
  5. 5.
    Anonymous. Feeling some sort of high or euphoria from hypoglycemia. Reddit website. 2016. Accessed 24 June 2018.
  6. 6.
    Marchetti P, Faloppa C, Zappella A, Navalesi R. A case of factitious hypoglycemia with unusual presentation. Minerva Med. 1988;79(12):1101–3.Google Scholar
  7. 7.
    Svirski B, Edoute Y. Sulfonylurea-induced factitious hypoglycemia. Harefuah. 1996;130(10):678–80.Google Scholar
  8. 8.
    Madae’en S, Bostamy B, Jaber D, Wazaify M. Death of a middle-aged man after long term abuse of a combination anticholinergic, beta blockers and narcotic drugs: a suspected Münchausen syndrome case report. J Addict Neuropharmacol. 2015;2(1):7–9.Google Scholar
  9. 9.
    Jaber D, Al-Awwa I, Wazaify M. Multiple prescription drug abuse and salt craving in a psychotic patient: a case report from a teaching hospital in Jordan. Int J High Risk Behav Addict. 2015;4(3):e22449.CrossRefGoogle Scholar
  10. 10.
    Blackwood GW. Severe psychological disturbance resulting from abuse of nasal decongestants. Scott Med J. 1982;27:175–6.CrossRefGoogle Scholar
  11. 11.
    Schmidt KT, Weinshenker D. Adrenaline rush: the role of adrenergic receptors in stimulant-induced behaviors. Mol Pharmacol. 2014;85(4):640–50.CrossRefGoogle Scholar
  12. 12.
    Zaniewska M, Filip M, Przegalinski E. The involvement of norepinephrine in behaviors related to psychostimulant addiction. Curr Neuropharmacol. 2015;13(3):407–18.CrossRefGoogle Scholar
  13. 13.
    Hieronymus L, O’Connell B. Understanding hypoglycemia. Diabetes self-management. 2017. Accessed 24 June 2018.
  14. 14.
    Siegel EG, Mayer G, Nauck M, Creutzfeldt W. Factitious hypoglycemia caused by taking a sulfonylurea drug. Dtsch Med Wochenschr. 1987;112(41):1575–9.CrossRefGoogle Scholar
  15. 15.
    Lebowitz MR, Blumenthal SA. The molar ratio of insulin to C-peptide: an aid to the diagnosis of hypoglycemia due to surreptitious (or inadvertent) insulin administration. Arch Intern Med. 1993;153(5):650–5.CrossRefGoogle Scholar
  16. 16.
    Hasche H, Bachmann W, Haslbeck M, Mehnert H. Hypoglycaemia factitia: three case descriptions. Self-inflicted hypoglycaemia (three cases). Dtsch Med Wochenschr. 1982;107(16):625–8.CrossRefGoogle Scholar
  17. 17.
    Glyburide dosage. Accessed 14 Oct 2018.
  18. 18.
    Jermendy G. Factitious hypoglycemia–Munchausen syndrome in diabetes mellitus. Orv Hetil. 1995;136(1):31–3.Google Scholar
  19. 19.
    Kenna GA, Wood MD. Prevalence of substance use by pharmacists and other health professionals. J Am Pharm Assoc. 2004;44(6):684–93.CrossRefGoogle Scholar
  20. 20.
    Snyder LL, Truong YK, Law JR. Evaluating substance use and insulin misuse in adolescents with type 1 diabetes. Diabetes Educ. 2016;42(5):529–37.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Biopharmaceutics and Clinical Pharmacy, School of PharmacyThe University of JordanAmmanJordan
  2. 2.Public Health InstituteLiverpool John Moores UniversityLiverpoolUK

Personalised recommendations