Diabetes Mellitus Q 87

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You are doing some teaching with a client who is starting on a sulfonylurea antidiabetic agent. The client mentions that he usually has a couple of beers each night and takes an aspirin each day to prevent heart attacks and/or strokes. Which of the following responses would be best on the part of the nurse?

  

    A. As long as you only drink two beers and take one aspirin, this should not be a problem

    B. The aspirin is alright but you need to give up drinking any alcoholic beverages

    C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause the development of hypoglycemia

    D. Aspirin and alcohol will cause the stomach to bleed more when on a sulfonylurea drug

    

    

Correct Answer: C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause the development of hypoglycemia

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Alcohol lowers blood glucose levels and disrupts the production of glucose in the liver. Sulfonylureas, when taken with alcohol, may produce a disulfiram-like reaction which may lead to flushing, hypotension, nausea, tachycardia, vertigo, and blurred vision. Metformin should be avoided in patients with a history of chronic alcohol use because they may be more predisposed to lactic acidosis.

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Option A: Insulin and oral hypoglycemics mixed with alcohol may increase the risk of hypoglycemic reactions. Chlorpropamide and possibly other sulfonylureas may produce a disulfiram-like reaction with alcohol, leading to flushing, hypotension, nausea, tachycardia, vertigo, dyspnea, and blurred vision.

Option B: The use of aspirin for the prevention of cardiovascular events, regardless of the dose, in patients with diabetes mellitus type II receiving sulfonylureas alone or in combination with other antidiabetic tablets, may increase the risk of hypoglycemia.

Option D: Alcohol suppresses gluconeogenesis, which may increase the risk for hypoglycemia in diabetic patients. The risk is further increased if the patient uses insulin or oral hypoglycemics. For patients on sulfonylureas, the literature suggests an increased risk of hypoglycemia, especially with the longer-acting first-generation sulfonylureas (tolbutamide and chlorpropamide). There may also be increased risk in second-generation sulfonylureas.

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