Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide?
A. “Be sure to take glipizide 30 minutes before meals.”
B. “Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.”
C. “You won’t need to check your blood glucose level after you start taking glipizide.”
D. “Take glipizide after a meal to prevent heartburn.”
Correct Answer: A. “Be sure to take glipizide 30 minutes before meals.”
The client should take glipizide twice a day, 30 minutes before a meal, because food decreases its absorption. The immediate release dosage form should be administered 30 minutes before meals to achieve the most significant reduction in postprandial hyperglycemia. Administration of the extended-release dosage form should be with breakfast or the first meal of the day. Practitioners should instruct patients to swallow the tablets whole and not to chew, split, or crush the tablets.
Option B: The drug doesn’t cause hyponatremia and therefore doesn’t necessitate monthly serum sodium measurement. The primary adverse effects of glipizide include hypoglycemia and weight gain. The most common adverse reactions are gastrointestinal and include nausea and diarrhea. In rare cases, cholestatic jaundice may result from glipizide therapy, and this requires immediate discontinuation of the medication.
Option C: The client must continue to monitor the blood glucose level during glipizide therapy. Monitor fasting plasma glucose and A1c at three months in patients taking glipizide. Some experts recommend monitoring liver enzymes and renal function in patients who are prescribed glipizide for more than two months.
Option D: Glipizide is a second-generation sulfonylurea that is FDA-approved for the treatment of adults with diabetes mellitus type 2. Its use is as an adjunct to diet and exercise. It is usable in combination with metformin, a biguanide, to reach goal HbA1c in patients with not adequate metabolic control in 3 months, despite compliance with diet, exercise, and medication.
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