Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)?
A. Give glyburide again
B. Give subcutaneous insulin and monitor blood glucose
C. Monitor blood glucose closely, and look for signs of hypoglycemia
D. Monitor blood glucose, and assess for signs of hyperglycemia
Correct Answer: C. Monitor blood glucose closely, and look for signs of hypoglycemia.
When a client who has taken an oral antidiabetic agent vomits, the nurse would monitor glucose and assess him frequently for signs of hypoglycemia. As rates for hypoglycemia can be higher with glyburide than other oral antidiabetic agents, close monitoring for signs and symptoms of declining blood glucose levels is required.
Option A: Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. It is necessary to monitor glyburide patients even further if they are in circumstances that provoke the onset of hypoglycemia: this includes exercise, lack of eating, and accidental overdosage.
Option B: Giving insulin would also lower the glucose levels, causing hypoglycemia. Knowledge of the signs and symptoms of hypoglycemia is vital when starting a patient on glyburide and self-monitoring of blood glucose and regularly scheduled testing of blood glucose and HbA1C as recommended by the ADA.
Option D: The client wouldn’t have hyperglycemia if the glyburide was absorbed. Glyburide toxicity is most likely to result from severe hypoglycemia from an excessive dosage, whether accidentally or intentionally. Drug-drug interactions with glyburide and other sulfonylureas due to duplicate metabolism through the CYP2C9 enzyme can also potentiate hypoglycemia.
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