A patient with type 1 diabetes who takes insulin reports taking ...

[j.rubin]

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.

Question 2

A patient has type 2 diabetes that has been well controlled by a sulfonylurea. However, recently the patient has been experiencing repeated hypoglycemic reactions. The nurse should assess the patient for
 
  a. infection.
  b. concomitant use of nonsteroidal anti-inflammatory agents.
  c. increased emotional stress.
  d. reduced physical activity level.

[Eazy416]

Answer to Question 1

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.

Answer to Question 2

ANS: B
A variety of drugs, such as NSAIDs, can intensify hypoglycemic responses to most sulfonylureas and therefore should be avoided by patients taking sulfonylureas.
Use of a sulfonylurea does not predispose patients to infection or increased emotional stress or cause them to reduce their physical activity level.

[j.rubin]

Excellent

[epscape]

TYSM