Hypoglycemic reactions

Sulfonamides may inhibit the (hepatic) metabolism of the oral hypoglycemic drugs tolbutamide (Orinase) and chloq ropamide (Diabinese). This would increase the possibility of a hypoglycemic reaction. 

The nurse must closely observe the patient after administering any insulin, but particularly U500 insulin, because secondary hypoglycemic reactions may occur as long as 24 hours after the administration. 

The nurse should check the patient for hypoglycemia (see Table 49-1) at the peak time of action of the insulin (see Summary Drug Table Insulin Reparations). Hypoglycemia, which can develop suddenly, may indicate a need for an adjustment in the insulin dosage or other changes in treatment, such asa change in diet. Hypoglycemic reactions can occur at any time but are most likely to occur when insulin is at its peak activity. 

Mediods of terminating a hypoglycemic reaction include die administration of one or more of die following... 

The nurse notifies the health care provider of any hypoglycemic reaction, die substance and amount used to terminate the reaction, blood samples drawn (if any), the length of time required for die symptoms of hypoglycemia to disappear, and die current status of the patient. After termination of a hypoglycemic reaction, the nurse closely observes die patient for additional hypoglycemic reactions. The lengtii of time close observation is required depends on die peak and duration of the insulin administered. 

Although elderly patients taking the oral antidiabetic drugs are particularly susceptible to hypoglycemic reactions these reactions may be difficult to detect in the elderly. The nurse notifies the health care provider if blood sugar tevetsare elevated (consistently > 200 mg/dL) or if ketones are present in the urine. 

Know the symptoms of hypoglycemia and hyperglycemia and the health care provider s method for terminating a hypoglycemic reaction. 

Hypoglycemic reactions are identified, reported to the health care provider, and managed successfully... 

Which of die following would the nurse mosdy likely choose to terminate a hypoglycemic reaction ... 

In patients receiving oral hypoglycemic dragp, the nurse must be aware that hypoglycemic reactions... 

To prevent a rebound hypoglycemic reaction from the sudden withdrawal of TPN containing a concentrated dose of dextrose, the rate of administration is slowly reduced or the concentration of dextrose gradually decreased. If TPN must be abruptly withdrawn, a solution of 5% or 10% dextrose is begun to gradually reduce the amount of dextrose administered. 

Hypoglycemic reactions - Hypoglycemia when using this concentrated insulin can be prolonged and severe. Deep secondary hypoglycemic reactions may develop 18 to 24 hours after the original injection of concentrated insulin. 

Hypoglycemic reaction (insulin reaction) sudden 0/0 fatigue, weakness, nervousness, confusion, headache, diplopia, convulsions, psychoses, dizziness, unconsciousness rapid, shallow... 

Elderly In elderly, debilitated, or malnourished patients, and patients with impaired renal or hepatic function, the initial and maintenance dosing should be conservative to avoid hypoglycemic reactions. 

Notify clinician when hypoglycemic reactions occur so that antidiabetic therapy can be adjusted... 

Hypoglycemic reactions are the most common complication of insulin therapy. They commonly result from inadequate carbohydrate consumption, unusual physical exertion, and too large a dose of insulin. 

Hypoglycemic reactions were more common at the highest dose, and were more common in the Japanese men. 

In an open comparative study in 57 patients acarbose and gliclazide had the same effects on HbAic, blood glucose, and lipids, although the ratio of HDL LDL cholesterol increased during acarbose therapy (51). Of those who took gliclazide 10% reported at least one mild hypoglycemic reaction. 

In an 8-week, non-interventional cohort study in 22 045 patients with type 2 diabetes, of whom 4.9% discontinued therapy, adverse advents occurred in 2.3% (52). There were attacks of hypoglycemia in 0.3%. Of the 6547 patients taking glimepiride, 2.5% had adverse reactions and 0.4% had hypoglycemic reactions. 

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