Sulfonylurea / insulin hypoglycaemia

Confirm glucose by capillary AND venous sample. Common agents: • Sulfonylureas (gliclazide, glipizide, glibenclamide) — long-acting, recurrent hypoglycaemia possible 24–72 h. • Meglitinides (repaglinide) — shorter-acting but similar mechanism. • Insulin (especially long-acting analogues — degludec up to 42 h). • Co-ingestion of alcohol potentiates hypoglycaemia. Features: tremor, sweating, tachycardia, hunger, anxiety; progressing to confusion, focal neurology, seizures, coma. Suspect in any unexplained altered mental state. ABCDE; bloods: glucose (lab + cap), C-peptide + insulin level if differentiating endogenous (insulinoma) vs exogenous (suppressed C-peptide with insulin), drug levels, paracetamol/salicylate, U&E, LFTs.