SAT-546 Severe Hypoglycemia and Neuroglycopenic Symptoms Induced by Ciprofloxacin in a Non-Medicated Diabetic Patient

Abstract Disclosure: D.X. Ramos Padilla: None. R. Adupa: None. D. Suravajjala: None. A. Ammu: None. M. Rajput: None. Background: Dysglycemia is a known complication of fluoroquinolone use. However, severe hypoglycemia associated with ciprofloxacin use in a diabetic patient who is not on antidiabetic medications is rare and underreported. Ciprofloxacin has been linked to hypoglycemic episodes, but the mechanism and the risk in patients not on hypoglycemic therapy warrant further attention. Clinical Case: A 59-year-old man with a long history of Type 2 Diabetes Mellitus (T2DM), who had not been on any hypoglycemic therapy for over a year, experienced recurring episodes of severe hypoglycemia, culminating in a seizure. The patient had been taking oral and otic ciprofloxacin for a right ear infection for 7 days before the hypoglycemic episodes began. He was not on any antidiabetic medications, including insulin. Frequent episodes of shaking, clamminess, and sweating, accompanied by seizures, necessitated hospitalization. Documented blood glucose levels during the episodes were as low as 35 mg/dL. The hypoglycemic symptoms were reversed by administering dextrose and discontinuing ciprofloxacin. Discussion: Ciprofloxacin can block ATP-sensitive potassium channels (KATP) in pancreatic β-cells, leading to membrane depolarization, calcium influx, and increased insulin secretion. Additionally, it inhibits GLUT1, which reduces cellular glucose uptake, and induces calcium release from intracellular stores via ryanodine receptors, further promoting insulin secretion. These mechanisms collectively increase the risk of hypoglycemia in diabetic patients, even those not on antidiabetic medications, by boosting insulin secretion and disrupting glucose homeostasis. This case report underscores the potential for ciprofloxacin to induce severe hypoglycemia and neuroglycopenia in diabetic patients, even in the absence of antidiabetic medications. Although previous studies have noted the risk of hypoglycemia with fluoroquinolones, this report highlights the less recognized scenario of severe hypoglycemia associated with ciprofloxacin use in diabetic patients who are not on glucose-lowering treatments. Given the serious consequences of severe hypoglycemia, it is vital for clinicians to recognize this risk when prescribing ciprofloxacin, especially to diabetic patients. Clinicians should consider alternative antibiotics or ensure close blood glucose monitoring for diabetic patients on ciprofloxacin, regardless of their use of antidiabetic medications. By documenting and sharing such cases, the medical community can improve understanding of ciprofloxacin's risks and take appropriate steps to minimize them. Presentation: Saturday, July 12, 2025