Due to confusion and lethargy, a 64-year-old woman is brought to the emergency department. When her husband left for work in the morning, she was asymptomatic, but when he returned home, she was weak and disoriented. The patient has type 2 diabetes mellitus and hypertension, both of which require multiple medications. She does not use tobacco, alcohol, or illicit drugs. The temperature is 37 ° C. (98.6 F), the blood pressure is 140/70 mm Hg, the pulse rate is 74 beats per minute, and the respirations rate is 18 beats per minute. The patient is somnolent on physical examination but withdraws all extremities due to pain. Serum C-peptide levels in the blood are elevated, according to laboratory results. If her current condition is due to an antidiabetic drug, which of the following is the most likely culprit agent?

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Eductional Objective: Proinsulin is cleaved into mature insulin and C-peptide, which are co-secreted in equimolar amounts by pancreatic beta cells. C-peptide levels in the blood can be used to assess endogenous insulin secretion. Sulfonylureas and meglitinides lower blood glucose levels by increasing pancreatic insulin secretion; hypoglycemia caused by these agents is associated with elevated C-peptide levels.

Due to Confusion and Lethargy, a 64-Year-Old Woman Is Brought