A type I diabetic patient comes to the clinic for a follow-up appointment. The patient 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 patient?
a. "You need to increase your insulin to allow for the agonist effects of metoprolol."
b. "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced."
c. "Metoprolol has no effects on diabetes mellitus or on your insulin requirements."
d. "Metoprolol may mask signs of hypoglycemia so you need to monitor your blood glucose
closely."
ANS: D
Metoprolol may mask the signs of hypoglycemia, therefore the patient should monitor the blood glucose closely and report changes to the prescriber.
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.
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 health care decision based on the drug-to-drug interaction rather than actual physiological factors.
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