Medical researchers have identified a dangerous and deceptive trend in the illicit drug market after two nondiabetic patients were admitted to intensive care with life-threatening hypoglycemia following heroin use. The cases, occurring years apart but linked by the same rare clinical presentation, reveal that heroin supplies are being contaminated with glipizide, a potent prescription medication traditionally used to treat type 2 diabetes.
The study, “Two cases (a decade apart) of severe sulfonylurea-positive hypoglycemia associated with inhaled heroin use,”recently published in JCEM Case Reports, details how both patients arrived at the hospital in critical condition, suffering from altered mental status and “seizure-like” movements. In both instances, blood glucose levels had plummeted to dangerously low levels — under 40 mg/dL — despite neither patient having a history of diabetes or access to glucose-lowering medications.
Laboratory analysis eventually confirmed that the patients were suffering from unintentional sulfonylurea poisoning. Sulfonylureas, such as glipizide, work by stimulating the pancreas to release massive, sustained amounts of insulin. When taken by individuals who do not have high blood sugar, the drug causes the body’s glucose levels to crash. This condition, known as hyperinsulinemic hypoglycemia, can lead to permanent neurological damage or death if not treated immediately with intravenous dextrose or specialized medications like octreotide, which acts as an “antidote” by suppressing insulin secretion.
“These cases highlight the critical importance of obtaining a detailed clinical history and acquiring timely laboratory samples,” the authors note. “Screening for sulfonylurea exposure is time-sensitive and can result negative if there is a delay in sending the test.”
Because the symptoms of severe hypoglycemia — confusion, sweating, and seizures — can mimic the effects of opioid withdrawal, stroke, or other toxicities, doctors may easily miss the underlying cause without specific metabolic testing.
Through careful investigation, the researchers found that the patients shared one common exposure: both had inhaled, or “snorted,” heroin mixed with an unknown additive shortly before their collapse. The first case involved a 61-year-old woman who required stabilization in the medical intensive care unit (MICU) after her blood sugar fluctuated wildly. The second case involving a 69-year-old man, was even more persistent. After an initial treatment and discharge, he suffered a second severe hypoglycemic crash just seven hours later, requiring a 24-hour MICU stay. This “rebound” effect is a hallmark of sulfonylurea poisoning, as the medication has a long half-life in the body. While sulfonylureas have occasionally been found in “street valium” or contaminated cocaine, this report marks a significant documentation of the drug being used as an adulterant in inhaled heroin. In 2004, there was an epidemic among youth in Texas of using “cheese heroin,” which is heroin crushed with over-the-counter cold/sleep tablets.
A similar trend of using heroin crushed with Dormin, a sleep aid containing Benadryl has also been documented. It is unclear whether mixing heroin with sulfonylureas is for profitability or whether this combination can have a similar desirable sedating effect after the drug high. The findings have prompted a call for medical professionals to broaden their diagnostic scope when treating suspected drug overdoses. Because the symptoms of severe hypoglycemia — confusion, sweating, and seizures — can mimic the effects of opioid withdrawal, stroke, or other toxicities, doctors may easily miss the underlying cause without specific metabolic testing.
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