A medication nurse is about to give insulin to a patient with diabetes mellitus. Upon reviewing the medications of the patient, which of the following would cause a further decrease in the blood glucose level of the patient?
A. hydrochlorothiazide (Microzide)
B. levothyroxine (Synthroid)
C. carvedilol (Coreg)
D. hydrocortisone (SoluCortef)
Correct Answer: C. carvedilol (Coreg)
Carvedilol (Coreg) is a beta-blocker when given together with insulin would cause an increased hypoglycemic effect of insulin, resulting in a further decrease in the serum blood glucose level. Carvedilol has hyperglycemic potential when given orally for 5 days in normal albino rats. Though it may be beneficial in diabetics for various comorbid conditions, the glycemic control may worsen during its use in subjects with prediabetes, diabetes, high risk diabetes.
Option A: Thiazide antihypertensive drugs (e.g., hydrochlorothiazide) and thiazide-like drugs (e.g., metolazone) are often prescribed to control blood pressure in people with diabetes. Thiazide diuretics are known to promote hyperglycemia and in some cases contribute to the new onset of diabetes.
Option B: It is likely that glucose levels will stabilize during hypothyroidism treatment. But when thyroid function is normalized, this may lead to higher blood glucose levels and adverse effects on glycemic control.
Option D: Hydrocortisone-induced hyperglycemia and it is possible that continuous hydrocortisone infusion would reduce the fluctuations in blood glucose levels and that tight blood glucose control could be better achieved with this approach.
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