Severe hypoglycemia occurred without warning in three elderly diabetic subjects while they were receiving moderate therapeutic doses of tolbutamide. The clinical picture of the condition mimicked cerebral vascular accident, thereby leading to diagnostic confusion. Severe hypoglycemia during tolbutamide therapy is apparently quite rare. Because of the large number of elderly people taking tolbutamide, in evaluating apparent cerebral vascular accidents in this group, a high index of suspicion of drug-induced hypoglycemia is recommended.
Gardner P, Goodner CJ, Dowling JT. Severe Hypoglycemia in Elderly Patients Receiving Therapeutic Doses of Tolbutamide. JAMA. 1963;186(11):991-993. doi:10.1001/jama.1963.03710110043009