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February 27, 2004

Hypoglycemia, Other

Question from Colorado Springs, Colorado, USA:

I'm a nursing student and getting ready to graduate. We learn a lot about type 1 diabetes due to its prevalence. I've researched it quite a bit. In studying for boards, it became quite a debate whether or not beta blockers such as metoprolol (Lopressor) can, and I say with emphasis, "induce" hypoglycemia. For example, does a type 2 diabetic need to have his glipizide dose lowered to accommodate beta blocker induced hypoglycemia? I know beta blockers can mask the sympathetic nervous system related responses of hypoglycemia, but I have yet to determine if they would actually produce a state of hypoglycemia. Can someone there give a little insight?

Answer:

Beta blockers to not induce low blood sugars. In fact, there is B2 inervation to the pancreatic islets that could, theoretically, decrease insulin secretion. As you say, they blunt the sympathetic symptoms associated with the condition. I am also asked whether I would hold off and not use beta blockers in people with diabetes. The problem is that there are no other class of drugs that have shown the same benefit post-MI. Therefore, you end up using the beta blockers and educating your patients about the interactions that may occur. This may involve more blood sugar monitoring or a change in medical regimen.

JTL