After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do?
A. Initiate insulin therapy.
B. Switch the client to a different oral antidiabetic agent.
C. Prescribe an additional oral antidiabetic agent.
D. Restrict carbohydrate intake to less than 30% of the total caloric intake.
Correct Answer: B. Switch the client to a different oral antidiabetic agent.
Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent. Therefore, it wouldn’t be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent.
Option A: Glipizide can be used concomitantly with insulin, but the dose of glipizide will typically need to be at the lower end of the dose range to prevent hypoglycemia. If discontinuation of insulin becomes necessary, then the patient’s urine and blood sugars should be monitored at least three times a day.
Option C: Second-generation sulfonylureas are considered to be more potent by weight when compared to the first-generation agents. Sulfonylureas were discovered in 1942 and have enjoyed extensive use in type 2 diabetes mellitus treatment since the 1960s.
Option D: Other drug classes used in the treatment of diabetes mellitus type 2 include alpha-glucosidase inhibitors, biguanides, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, glinides, and thiazolidinediones.
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