Avoiding Drug-Induced Hypoglycemia in the Older Adult

Mary Ann E. Zagaria, PharmD, MS, BCGP


US Pharmacist. 2019;44(10):4-10. 

In This Article

Prevention of Drug-induced Glucose and Insulin Imbalance

A risk-benefit evaluation should be considered for each individual patient, bearing in mind that in a high-risk patient, avoidance of potentially causative drugs may be the best preventive strategy, although not always possible. The following general preventive strategies have been recommended:[4]

Avoid Concomitant Use of: more than one drug that can cause glucose and/or insulin dysregulation; drugs that could cause pharmacokinetic or pharmacodynamic drug interactions with a potentially causative drug.

At Each Visit: Inquire about any symptoms of hypoglycemia or hyperglycemia; monitor weight.

Monitor Fasting Plasma-Glucose Concentration: within the first few weeks following the initiation of high-risk drugs, and regularly thereafter, particularly in the presence of weight changes or preexisting disorders of glucose metabolism; in addition to postprandial plasma-glucose concentration monitoring, for patients taking glucocorticoids.

Obtain Baseline Fasting Plasma Glucose Level: prior to initiation of potentially causative drugs, especially in patients with risk factors.

Low Dose and Short Duration: When a potentially offending drug is necessary, use at the lowest effective dose for the shortest duration of therapy, if possible.