Có bằng chứng nào về tác dụng phụ của điều trị? Bạn đã kiểm tra vị trí tiêm? 8 phòng thí nghiệm theo dõi Xem xét việc kiểm tra chức năng thận vì điều này sẽ làm thay đổi giải phóng mặt bằng insulin. | 70 I ORAL HYPOGLYCAEMIC TREATMENT Table Drug interactions with sulphonylureas Lower blood glucose Raise blood glucose General Alcohol flushing Antimicrobials Chloramphenicol Co-trimoxazole Miconazole Sulphonamides Rifampicin Cardiovascular Beta blockers reduce hypo warning Diazoxide Loop diuretics Nifedipine Thiazides Anticoagulant Warfarin Gastrointestinal H2 antagonists Endocrine Metabolic Octreotide Corticosteroids Contraceptives Joints Aspirin Phenylbutazone NSAIDs Sulphinpyrazone Azapropazone Psychotropic MAO Is Lithium Phenobarbitone Tricyclics postural hypotension hypoglycaemia on as small a dose as mg and can also cause prolonged hypoglycaemia. Glibenclamide is the commonest cause of hypoglycaemia due to oral agents. One in three patients taking glibenclamide experience hypoglycaemia. Tolbutamide and glipizide are both short-acting and can be linked to meals to allow some patients flexibility in dosage small meals small dose big meal big dose. Gliclazide reduces platelet stickiness which could reduce the risk of vascular complications but glucose-lowering itself can have effects on platelets. Gliclazide also seems less likely to produce sudden hypoglycaemia than glibenclamide it is becoming increasingly popular but costs more. At risk patients 1 Old age Start on a very small dose and increase it cautiously. Tolbutamide or glipizide are short-acting and perhaps safer. Gliclazide may also be used but is longer-acting. Emphasize the need for regular meals. 2 Cardiac disease Metformin may cause lactic acidosis in severe cardiac failure or hypotension. With sulphonylureas beta blockers can reduce symptoms of hypoglycaemia and thiazide diuretics reduce the glucose-lowering effect. ACE inhibitors may cause hypoglycaemia. WHICH DRUG I 71 3 Renal disease All glucose-lowering agents are potentially hazardous in patients with reduced creatinine clearance. Gliclazide and gliquidone are the best options but insulin will probably be needed. Metformin is .
