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Sulfonylurea hypoglycaemia — GPhC CRA MCQ

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EasyEndocrine TherapeuticsSulfonylurea hypoglycaemiaGPhC CRA

A 68-year-old man with type 2 diabetes takes gliclazide 80 mg twice daily and metformin 1g twice daily. He has been feeling lightheaded, sweaty, and shaky before lunch. His pre-lunch capillary glucose is 3.1 mmol/L. What is the most appropriate advice?

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Correct answer: D — Advise him to eat a sugary snack immediately and then eat his lunch; advise GP review of gliclazide dose

Symptoms of shakiness, sweating, and lightheadedness with a capillary glucose of 3.1 mmol/L are consistent with hypoglycaemia. Sulfonylureas such as gliclazide are a common cause of hypoglycaemia, particularly in elderly patients or those with irregular eating patterns. Immediate treatment is to consume fast-acting glucose (e.g. glucose tablets, sugary drink) followed by a longer-acting carbohydrate. The GP should review the gliclazide dose. Metformin does not cause hypoglycaemia when used alone.

Reference: BNF Gliclazide; NICE NG28 Type 2 Diabetes