Braet C, et al. Cureus 2020.
Type 2 diabetes mellitus is highly prevalent among patients with cirrhosis. The pharmacological management of this disease in patients with chronic liver disease remains controversial, however. Insulin secretagogues such as sulfonylureas are associated with a high risk of hypoglycemia among diabetics. In patients with cirrhosis, this risk is more pronounced due to decreased hepatic clearance, concurrent alcoholism, hypoalbuminemia, and acute liver decompensation. In this case report, we present a case of severe refractory hypoglycemia secondary to glipizide in a patient with alcoholic cirrhosis. We believe that the use of sulfonylureas in this patient population should be contraindicated to avoid debilitating neurologic damage and death following hypoglycemia.