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Sulfonylurea-related hypoglycaemia — GPhC CRA MCQ

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ModerateEndocrine TherapeuticsSulfonylurea-related hypoglycaemiaGPhC CRA

A 62-year-old man with type 2 diabetes managed on gliclazide 80 mg twice daily and metformin 1 g twice daily attends the pharmacy. He mentions he has been experiencing episodes of sweating, tremor, and confusion in the late morning. His HbA1c is 48 mmol/mol. What is the most appropriate advice?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Refer him to his GP as these symptoms suggest hypoglycaemia, likely related to gliclazide, and his diabetes control may be over-tight

The symptoms described — sweating, tremor, and confusion — are classic features of hypoglycaemia. Gliclazide is a sulfonylurea that stimulates insulin secretion regardless of blood glucose levels, and hypoglycaemia is a recognised side effect. With an HbA1c of 48 mmol/mol, the patient's diabetes is well controlled and may be over-treated. The GP should review whether the gliclazide dose can be reduced.

Reference: BNF; NICE NG28 Type 2 Diabetes