Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-53 A number of medications to treat other medical conditions can cause hyperglycemia, hypoglycemia or new onset diabetes. It is important health-care providers be aware of medications that can alter glycemic levels in both people with diabetes and those at risk. Intermittent laboratory monitoring may be necessary to assess the impact of these medications on glycemic control. People with diabetes should be instructed to increase the frequency of glucose monitoring, monitor for signs and symptoms of hyperglycemia and/or hypoglycemia and when to contact their health-care team.

Table 11. Drug interactions (125-131) Agent

Effects and mechanism of action

Beta-blockers

• Cardioselective beta-blockers (atenolol, metoprolol) are preferred over nonselective beta-blockers (propranolol, nadolol); less likely to block the counter regulatory effect of epinephrine. • Non-selective beta-blockers should be used cautiously in people with diabetes: o Mask the initial signs and symptoms of catecholamine-mediated hypoglycemia (palpitations, tremor, hunger), impairing recognition. • Mechanism: Have the potential to prolong a hypoglycemic event due to impairment of the counterregulatory effect of epinephrine, causing decreased hepatic glucose production in response to a low BG level. • People should be informed that their beta-blocker may delay the recognition of hypoglycemia, and they may need more frequent BG monitoring to minimize risk of hypoglycemia