Glimepiride

INTRODUCTION

Indications

PO: Control of blood sugar in type 2 diabetes mellitus when diet therapy fails. Requires some pancreatic function.

Action

Lowers blood sugar by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. May also decrease hepatic glucose production. May be used concurrently with metformin when the combination of diet, exercise, and either drug alone fails to produce glycemic control. Therapeutic Effects: Lowering of blood sugar in diabetic patients.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, headache, weakness. GI: constipation, cramps, diarrhea, drug-induced hepatitis, dyspepsia, increased appetite, nausea, vomiting. Derm: photosensitivity, rashes. Endo: hypoglycemia. F and E: hyponatremia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of hypoglycemia, especially during and after exercise. Common neuromuscular signs include anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nervousness; tremor; weakness; unsteady gait. Report persistent or repeated episodes of hypoglycemia to the physician.

• Assess any dizziness (See Appendix C) or drowsiness that might impair gait, balance, and other complex motor tasks (driving a car). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor signs of low sodium levels (hyponatremia), including headache, confusion, lethargy, irritability, decreased consciousness, and neuromuscular abnormalities (muscle weakness and cramps). Report severe or prolonged signs to the physician.

• Assess blood pressure periodically (See Appendix F). A sudden or sustained increase in blood pressure (hypertension) may indicate problems in diabetes management, and should be reported to the physician.

Interventions

• Implement aerobic exercise and endurance training programs to maintain optimal body weight, improve insulin sensitivity, and reduce the risk of macrovascular disease (heart attack, stroke) and microvascular problems (reduced blood flow to tissues and organs that causes poor wound healing, neuropathy, retinopathy, and nephropathy).

• Provide a source of oral glucose (fruit juice, glucose gels/tablets, etc.) to treat mild hypoglycemia. Call for emergency assistance if symptoms persist or in cases of severe hypoglycemia. Emergency treatment typically consists of IV glucose, glucagon, or epinephrine.

• Causes photosensitivity; use care if administering UV treatments.

Patient/Client-Related Instruction

• Encourage patient to monitor blood glucose before and after exercise and to adjust food intake to maintain normal glycemic levels.

• Emphasize the importance of adhering to nutritional guidelines and the need for periodic assessment of glycemic control (serum glucose and glycosylated hemoglobin levels) throughout the management of diabetes mellitus.

• Advise patient about symptoms of hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, ...