Hypoglycemia is an uncommon clinical problem in patients without diabetes mellitus. Potential aetiologies include drugs, critical illness, hormone deficiencies, and non islet cell tumors. In the absence of these causes, the possibility of accidental, surreptitious, or even malicious hypoglycemia should be considered. We present three cases of severe, prolonged hypoglycemia occurring spontaneously in healthy young men without a history of diabetes mellitus or chronic illness. All these patients were admitted to our hospital on the same day and although unrelated to each other resided in the same locality. All had an addiction to street drugs and in particular had used a street diazepam tablet known on the street markets as MSJ prior to presentation. On arrival to hospital our patients were semi-comatose with significantly low blood glucose readings (range 0.82.6 mmol/L). Hypoglycaemia was prolonged necessitating continuous dextrose infusions for up to 2436 hours after presentation. One patient presented with palpitations to accident & emergency later developed an altered sensorium. Investigations revealed blood glucose 2.6 mmol/L with corresponding C- peptide 3204 pmol/L and insulin 67.3 mU/L. Urine was positive for benzodiazepines and methadone. Urine screen for sulphonylureas negative but it was done 36 hours after admission. No further episodes of spontaneous hypoglycaemia were reported in our patients. These episodes of hypoglycaemia raises concerns of street diazepam contamination or substitution with sulphonylureas. Further inquiries in the area have revealed that a new brand of MSJ tablets believed to be introduced into the street markets in the locality in that period.
Conclusion: Recreational use of street diazepam is a growing problem. Endocrinologists and Clinicians in emergency departments should be aware of the possibility of street drug contamination or substitution with sulphonylureas in individuals presenting with unexplained prolonged hypoglycaemia.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.