رجل عمره ٦٦ سنة يأخذ جلايبنكلاميد، وُجد في البيت مشوشاً لا يستطيع البلع بأمان، يتعرق، والسكر ٣٨. زوجته اتصلت بالإسعاف. بعد الجلوكوز الوريدي صحا، لكن بعد ٣ ساعات رجع السكر ٥٤. ما التفسير الأرجح؟

A 66-year-old man on glibenclamide is found confused at home, unable to swallow safely, sweaty, with glucose 38. After IV glucose he wakes, but three hours later glucose is again 54. What is the most likely explanation?

1. A meter error, as hypoglycaemia does not recur
2. A long-acting sulfonylurea causes recurrent hypoglycaemia for hours
3. IV glucose raises insulin and causes the hypoglycaemia
4. New-onset type 1 diabetes starting now

Answer: B) A long-acting sulfonylurea causes recurrent hypoglycaemia for hours. Glibenclamide stimulates insulin release for many hours, especially in older adults and kidney disease, causing recurrence. Admission, glucose monitoring, dextrose infusion and drug review are needed.