Geriatric Patient With Repetitive Hypoglycaemic Episodes

Year 2005, Volume: 2 Issue: 4, 169 - 172, 01.12.2005

Mehmet Akif Büyükbeşe Ali Çetinkaya Ekrem Doğan

Abstract

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Keywords

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Geriatric Patient With Repetitive Hypoglycaemic Episodes

Abstract

Hypoglycaemia is one of the significant hospitalization reasons in elderly patients with diabetes mellitus. Concerns should increase in admission of such a case in the emergency room owing to a number of associated disorders which may contribute to the undesired consequences. An eighty-year-old diabetic woman who was on glimepiride therapy was brought to the emergency unit because of repeated episodes of hypoglycaemia. She was having Alzheimer\'s disease leading to forget the usual dose she was receiving that also gives rise to double the pill together with skipping the snacks. Age related changes in pharmacokinetics and the potential for adverse effects and drug interactions due to polypharmacy leading to interactions and less adherence to receive the right dose at the right time should also be considered when choosing appropriate pharmacological therapy. Geriatric patients require special considerations related to delayed response of counter-regulatory hormones to hypoglycaemia and associated conditions must be taken into consideration for a successful management program. Key words: Diabetic, glimepiride, hypoglycaemia, geriatric.

Keywords

Diabetic, glimepiride, hypoglycaemia, geriatric

References

• Gill V, Huddle KR. Hypoglycemic admissions among diabetic patients in Soweto, South Africa. Diabetic Med 1993;10:181-3
• UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998;352:837-53
• Van Staa T, Abenhaim L, Monette J. Rates of hypoglycemia in users of sulfonylureas. J Clin Epidemiol 1997;50: 735-41
• Comi RJ, Gorden P. Hypoglycaemic disorders in the adult; in Principles and Practice of Textbook of Endocrinology and Metabolism, Becker KL ed, Lippincott Williams and Wilkins, Philadelphia, 2001, pp 1469-77
• Grunberger G. Insulin resistance in a case of coexisting insulinoma and type 2 diabetes. Acta Diabetol 1993;30:243-50
• Service FJ, Dale AJD, Elveback LR, Jiang NS. Insulinoma: Clinical and diagnostic features of 60 consecutive cases. Mayo Clin Proc 1973;5:417-28
• Rosenstock J. Management of type 2 diabetes mellitus in the elderly: special considerations. Drugs Aging 2001;18: 31-44
• Ben-Ami H, Nagachandran P, Mendelson A, Edoute Y. Drug-induced hypoglycemic coma in 102 diabetic patients. Arch Intern Med 1999;159:281-4
• Jennings AM, Wilson RM, Ward JD. Symptomatic hypoglycaemia in NIDDM, patients treated with oral hypoglycaemic agents. Diabetes Care 1989;12:203-8
• Graal MB, Wolffenbuttel BH. The use of sulphonylureas in the elderly. Drugs Aging 1999;15:471-81
• Meneilly GS, Tessier D. Diabetes in the elderly. Diabet Med 1995;12:949-60
• Irsigler K: Hypoglycaemia in diabetes mellitus. Acta Med Austriaca 1992;19: 100-5
• Massi-Benedetti M. Glimepiride in type 2 diabetes mellitus: a review of the worldwide therapeutic experience. Clin Ther 2003;25:799-816
• Holstein A, Plaschke A, Hammer C, Egberts AH. Characteristics and time course of severe glimepiride versus glibenclamide-induced hypoglycaemia. Eur J Clin Pharmacol 2003;59:91-7
• Varas C, Rueda AM. Diabetes and renal impairment in the US elderly population. The Third National Health and Nutrition Examination Survey (NHANES III, 1988- 1994). Epidemiologic report. Bethesda, MD, USA: National Heart, Lung and Blood Institute, 2001
• Schernthaner G, Grimaldi A, Di Mario U et al. GUIDE Study: double-blind comparison of once daily gliclazide MR and glimepride in type 2 diabetic patients. Eur J Clin Invest 2004;34:535-42