Background: Toxicity from anti diabetic drugs may occur for many reasons accidental and suicidal. Some patients deliberately overdose on medications. In other cases, therapeutic misadventures and medication administration errors cause unintentional poisoning. Aim of the work: The aim of this study is to identify the incidence of anti diabetic drugs acute toxicity in patients presented to National Environmental and Clinical Toxicology and Research Center, Cairo university “Cairo and Giza governorates", During 2022 (From January to December 2022). To give an idea about demographic data (age, sex, residence, and marital status), circumstances of toxicity, common clinical presentations, severity of the toxicity, management plan and final outcome. Subjects and Methods: The study included 100 cases who were admitted at NECTR during 2022. Cases were analyzed regarding demographic data, circumstances of toxicity, common clinical presentations, severity of the toxicity, management plan, and final outcome. Results: The most common types of anti diabetic drugs toxicity are bigunaides and insulin. Most cases were not diabetic, were suicidal attempts, stayed from 24 to 72 hours in the hospital and discharged on their own responsibility. In this study; 88 case was >18 years, 89 patients were Females; 95 case were urban residents; 54 cases were married; 84 cases were non-working, Metformin was the most common type of antidiabetic drugs toxicity (73 case). Conclusions: Anti-diabetic drug toxicity is a critical issue that may be suicidal, accidental.