A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. The nurse is concerned because
a. the beta blocker can cause insulin resistance.
b. using the two agents together increases the risk of ketoacidosis.
c. propranolol increases insulin requirements because of receptor blocking.
d. the beta blocker can mask the symptoms of hypoglycemia.
ANS: D
Beta blockers can delay awareness of and response to hypoglycemia by masking signs associated with stimulation of the sympathetic nervous system (eg, tachycardia, palpitations) that hypoglycemia normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which the body can counteract a fall in blood glucose; beta blockers, therefore, can worsen insulin-induced hypoglycemia.
Propranolol does not cause insulin resistance.
The incidence of DKA is not increased by concurrent use of propranolol and insulin.
Insulin requirements are not increased because of receptor blocking by propranolol.
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