Have you noticed these 7 problems when prescribing medicines for patients with diabetes and these common diseases?

*For medical professionals to read for reference, let's see how many problems can you find this time? Diabetic patients are often accompanied by multiple complications or other diseases
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For patients with diabetes and these common diseases, what problems should be paid attention to in the process of clinical medication? Prescription 1 patient female, diagnosed with diabetes and coronary heart disease
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Prescribe aspirin enteric-coated tablets 100 mg orally three times a day; glimepiride tablets 1 mg orally once a day
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Click on the blank space to see the answer analysis: Aspirin can enhance the hypoglycemic effect of glimepiride.
The combination of the two drugs increases the risk of hypoglycemia, and may cause dizziness, sweating, tachycardia, and various neurological and mental symptoms
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When combined, the monitoring of blood glucose and hypoglycemia symptoms should be strengthened, and the dose should be adjusted in time
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Prescription 2 is a male patient, diagnosed with diabetes, hyperuricemia, and hypertension
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Prescribe hydrochlorothiazide tablets 25mg orally once a day; Metformin extended-release tablets 500mg orally once a day
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Click on the blank space to see the answer analysis: Hydrochlorothiazide can cause blood sugar to rise, and can interfere with renal tubular excretion of uric acid, causing hyperuricemia.
It is not suitable for patients with diabetes and hyperuricemia
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Prescription 3 patient female, diagnosed with type 2 diabetes and upper respiratory tract infection
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Prescribe metformin tablets 500mg orally three times a day; levofloxacin tablets 750mg orally once a day
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Click on the blank space to see the answer analysis: Quinolones can cause hyperglycemia, and combined use with antidiabetic drugs may cause blood sugar disorders, and blood sugar should be closely monitored when combined
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Prescription 4 patients were female, diagnosed with supraventricular tachycardia and type 2 diabetes
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Prescribe digoxin tablets 0.
5mg orally once a day and acarbose 100mg orally three times a day
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Click the blank space to see the answer analysis: The combination of acarbose and digoxin can affect the bioavailability of digoxin and reduce its plasma concentration and pharmacological effects
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When combined, it is recommended to strengthen the monitoring of plasma concentration and clinical manifestations, and adjust the dose of digoxin as appropriate
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Prescription 5 patients were female, diagnosed with coronary heart disease and type 2 diabetes
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Prescribe hydroclopidogrel tablets 75mg orally once a day; repaglinide tablets 2mg orally three times a day
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Click on the blank to see the answer analysis: Clopidogrel hydrogen sulfate can increase the blood concentration of repaglinide by inhibiting the metabolism of repaglinide through CYP2C8, and enhance its pharmacological effect
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When combined, it should be noted that the initial dose of repaglinide should be adjusted to 0.
5 mg once, taken with meals, and the dose should be adjusted according to the blood sugar level.
The daily dose of repaglinide should generally not exceed 4 mg
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Prescription 6 patient male, diagnosed with heart failure and type 2 diabetes, prescribed bisoprolol tablets 5 mg orally once a day
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Pioglitazone tablets 30 mg orally once a day
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Click on the space to see the answer: Bisoprolol may mask symptoms of hypoglycemia
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Pioglitazone may cause or exacerbate congestive heart failure and should be avoided in patients with heart failure
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For some patients on thiazolidinediones, close monitoring for signs and symptoms of heart failure [eg, abnormally rapid weight gain, dyspnea, and/or edema] should be initiated or dose increased
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Signs and symptoms of heart failure should be managed according to standard treatment regimens, with discontinuation or dose reduction
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 Prescription 7 patient male, diagnosed with type 2 diabetes mellitus and renal insufficiency
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Clinical examination: eGFR20 mL/min/1.
73m2
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Prescribe insulin glargine 20IU subcutaneously every night and acarbose 100mg orally three times a day
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Click on the blank space to see the answer analysis: Acarbose is contraindicated in patients with severe renal impairment
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For patients with renal insufficiency, when eGFR≥60 mL/min/1.
73m2, commonly used hypoglycemic drugs can be used normally; when eGFR＜60 mL/min/1.
73m2, most hypoglycemic drugs need to be reduced or banned.
The drugs used in the whole process include insulin preparations, linagliptin,
etc.

References: [1] Endocrinology Branch of Chinese Medical Association.
Expert consensus on the combination therapy of oral hypoglycemic drugs in Chinese adults with type 2 diabetes [J].
Chinese Journal of Endocrinology and Metabolism, 2019, 3(5): 196-199.
[2] Zhonghua Diabetes Branch of the Medical Association.
Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition [J].
) Chinese Journal of Diabetes, 2021.
13(4): 315-409.