A patient with type 1 diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol [Lopressor]. What education should the nurse provide to the pa-tient?
a. "Metoprolol has no effect on diabetes mellitus or on your insulin requirements."
b. "Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose."
c. "Metoprolol may mask signs of hypogly-cemia, so you need to monitor your blood glucose closely."
d. "Metoprolol may potentiate the effects of the insulin, so the dose should be re-duced."
C
Because metoprolol may mask the signs of hypoglycemia, the patient should monitor the blood glucose closely and report changes to the prescriber. Metoprolol does have an indirect effect on diabetes mellitus and/or insulin requirements in that it may mask the signs of hypoglycemia, causing the patient to make a healthcare decision based on the drug-to-drug interaction rather than actual physiologic factors. The patient should not increase the insulin, because metoprolol will cause a decrease in blood glucose, increasing the risk of a hypoglycemic reaction. The patient should not reduce the dose of insulin when taking metoprolol, because this might alter serum glucose levels.
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