The nonmicronized formulation (Diabeta) cannot be used interchangeably with the micronized formulation (Glynase PresTab)
PO (Adults): DiaBeta (nonmicronized)– 2.5–5 mg once daily initially (range 1.25–20 mg/day). Glynase PresTab (micronized)– 1.5–3 mg/day initially (range 0.75–12 mg/day; doses >6 mg/day should be given as divided doses). Increments should not exceed 1.5 mg/wk.
PO Geriatric Patients: DiaBeta (nonmicronized)– 1.25–2.5 mg/day initially; may be ↑ by 2.5 mg/day weekly. Glynase PresTab (micronized)– 0.75–3 mg/day; may be ↑ by 1.5 mg/day weekly.
Observe for signs and symptoms of hypoglycemic reactions (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety). Patients on concurrent beta-blocker therapy may have very subtle signs and symptoms of hypoglycemia.
Assess patient for allergy to sulfonamides.
Lab Test Considerations:
Monitor serum glucose and glycosylated hemoglobin (HbA1C ) periodically during therapy to evaluate effectiveness.
Monitor CBC periodically during therapy. Report ↓ in blood counts promptly.
May cause an ↑ in AST, LDH, BUN, and serum creatinine.
Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated with administration of oral glucose. Severe hypoglycemia should be treated with IV D50W followed by continuous IV infusion of more dilute dextrose solution at a rate sufficient to keep serum glucose at approximately 100 mg/dL.
High Alert: Accidental administration of oral hypoglycemic agents to non-diabetic adults and children has resulted in serious harm or death.
Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
To convert from other oral hypoglycemic agents, gradual conversion is not required. For insulin dose of less than 20 units/day, change to glyburide can be made without gradual dose adjustment. Patients taking 20 or more units/day should convert gradually by receiving glyburide and a 25–30% reduction in insulin dose every day or every 2nd day with gradual insulin dose reduction as tolerated. Monitor serum or glucose and ketones at least 3 times/day during conversion.
PO May be administered once in the morning or divided into 2 doses. Administer with meals to ensure best diabetic control and to minimize gastric irritation. Do not administer after last meal of the day.
Nonmicronized glyburide should not be taken with a meal high in fat. Micronized glyburide cannot be substituted for nonmicronized glyburide Preparations are not equivalent.
Instruct patient to take medication at same time each day. Take missed doses as soon as remembered unless almost time for next dose. Do not take if unable to eat.
Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to drink a glass of orange juice or ingest 2–3 tsp of sugar, honey, or corn syrup dissolved in water or an appropriate number of glucose tablets and notify health care professional.
Concurrent use of alcohol may cause a disulfiram-like reaction (abdominal cramps, nausea, flushing, headaches, and hypoglycemia).
Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hypoglycemic or hyperglycemic episodes.
Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified if significant changes occur.
May occasionally cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Caution patient to avoid other medications, especially aspirin and alcohol, while on this therapy without consulting health care professional.
Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
Advise patient to notify health care professional promptly if unusual weight gain, swelling of ankles, drowsiness, shortness of breath, muscle cramps, weakness, sore throat, rash, or unusual bleeding or bruising occurs.
Insulin is the recommended method of controlling blood sugar during pregnancy. Counsel female patients to use a form of contraception other than oral contraceptives and to notify health care professional promptly if pregnancy is planned or suspected or if breastfeeding.
Advise patient to carry a form of sugar (sugar packets, candy) and identification describing disease process and medication regimen at all times.
Emphasize the importance of routine follow-up exams.
Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.
glyBURIDE is a sample topic from the Davis's Drug Guide.
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