A 78-year-old client with type 2 diabetes lives alone and ta… | MyMerci
Adverse Effects/Contraindications/InteractionsPA
Question
A 78-year-old client with type 2 diabetes lives alone and takes glipizide 10 mg orally before breakfast. The home health nurse arrives at 1100 to find the client confused, diaphoretic, and tremulous. The client says they took the morning glipizide but did not eat breakfast because of nausea. Bedside blood glucose is 42 mg/dL. Which sequence of actions is most appropriate?
1Hold the next dose only and continue normal activities once symptoms resolve.
2Treat hypoglycemia per protocol (oral 15 g rapid carb if able to swallow, or call EMS / give IM glucagon if unable), recheck blood glucose in 15 minutes, plan continued observation because sulfonylurea-induced hypoglycemia often recurs and may require IV dextrose infusion and inpatient monitoring; identify cause (missed meal) and adjust plan with the provider.✓ Correct answer
3Give 16 oz of orange juice with sugar added and re-check in 15 minutes.
4Give an additional 10 mg glipizide to balance the missed meal effect.
Explanation
Sulfonylurea-induced hypoglycemia — extended observation Sulfonylureas (glipizide, glyburide, glimepiride) stimulate pancreatic beta cells to secrete insulin and can cause prolonged, recurrent hypoglycemia, especially in: • Elderly (impaired counter-regulation, slower drug clearance). • Missed meal. • Renal/hepatic impairment. • Drug interactions (sulfa, beta-blockers, alcohol).
Glyburide has the longest half-life and is generally avoided in the elderly per Beers list.
Management of severe sulfonylurea hypoglycemia: (1) 15-15 rule if alert and swallows safely: 15 g rapid carb, recheck in 15 min, repeat if needed. (2) If unable to take orally / unconscious: IM/SC glucagon 1 mg or call EMS for IV D50W; lateral position; airway monitoring. (3) EXTENDED OBSERVATION: sulfonylurea-induced hypoglycemia often recurs (8-24 h) — admission for IV dextrose infusion (D5W or D10W) and serial BG monitoring; octreotide IV/SC may be used to suppress further insulin release. (4) Identify cause: missed meal, dose error, drug interaction, renal decline. (5) Provider review: dose reduction, switch to safer agent (DPP-4, GLP-1, SGLT-2, metformin), monitor renal function. (6) Patient/family education: never skip meals after sulfonylurea, watch hypoglycemia signs, glucose tablets in pocket.
Other options: 16 oz juice with extra sugar gives way more than 15 g·potential rebound hyperglycemia. Holding next dose only ignores risk of recurrence within hours. Adding 10 mg glipizide is dangerous — would cause more severe hypoglycemia.
In-depth explanation
Clinical reasoning summary Sulfonylurea-induced hypoglycemia — extended observation Sulfonylureas (glipizide, glyburide, glimepiride) stimulate pancreatic beta cells to secrete insulin and can cause prolonged, recurrent hypoglycemia, especially in: • Elderly (impaired counter-regulation, slower drug clearance). • Missed meal. • Renal/hepatic impairment. • Drug interactions (sulfa, beta-blockers, alcohol).
Glyburide has the longest half-life and is generally avoided in the elderly per Beers list.
Management of severe sulfonylurea hypoglycemia: (1) 15-15 rule if alert and swallows safely: 15 g rapid carb, recheck in 15 min, repeat if needed. (2) If unable to take orally / unconscious: IM/SC glucagon 1 mg or call EMS for IV D50W; lateral position; airway monitoring. (3) EXTENDED OBSERVATION: sulfonylurea-induced hypoglycemia often recurs (8-24 h) — admission for IV dextrose infusion (D5W or D10W) and serial BG monitoring; octreotide IV/SC may be used to suppress further insulin release. (4) Identify cause: missed meal, dose error, drug interaction, renal decline. (5) Provider review: dose reduction, switch to safer agent (DPP-4, GLP-1, SGLT-2, metformin), monitor renal function. (6) Patient/family education: never skip meals after sulfonylurea, watch hypoglycemia signs, glucose tablets in pocket.
Other options: 16 oz juice with extra sugar gives way more than 15 g·potential rebound hyperglycemia. Holding next dose only ignores risk of recurrence within hours. Adding 10 mg glipizide is dangerous — would cause more severe hypoglycemia.