Discussion Prompt #2: Susan
When a patient like Susan, has both hypertension and diabetes, they are given different medications to control both conditions. Beta-blockers stop the effects of the hormone norepinephrine (adrenaline) which in turn causes the heart to beat slower (Pietrangelo, 2019). This controls blood pressure and lowers chances of complications related to blood pressure. When a patient is then placed on regular insulin to control their blood sugar, the combination of both the beta blocker and insulin can become problematic for the patient due to the effect beta blockers have on the body in correlation to what is expected in blood sugar responses. For example, when someone is beginning to be hypoglycemic, the heart rate usually goes up which in turn makes an individual feel faint, however, when that individual is on a beta blocker, the beta blocker slows the heart rate and masks the hypoglycemic effect of the heart which makes catching hypoglycemia more difficult for patients. On the other hand, Khalid et al. (2021) mentions that high dose regular insulin can be used for beta blocker toxicity treatment since it increases cardiac contractility, showing that both medications have opposite effects on certain parts of the body. Since both medications have opposing effects, it is important to closely monitor the patient who is taking both. Some may mention that if both medications act in opposing manners for certain items, why prescribe them together? In the past, Mills & Horn (1985), had mentioned that insulin- dependent diabetics could have prolonged, enhanced or altered symptoms of hypoglycemia while those who were not insulin dependent were seeing issues with hyperglycemia due to the antagonistic action of beta blockers on oral hypoglycemic medications. However, recent studies have found that beta blockers help diabetic patients in cardiac health more so than non-diabetic patients and therefore should not be ruled out as a possible medication to give a diabetic patient (Majumdar, 1999).
When it pertains to whether one beta blocker is better than another when dealing with patients that are both hypertensive and diabetic, Kveiborg et al. (2010) mentions that carvedilol is better than metropolol in diabetics. The article mentions that unlike other beta blockers, carvedilol does not create insulin resistance. Thus the conclusion of the study trial showed that patients who took carvedilol preserved their vascular insulin sensitivity while those on metropolol did not. Nebivolol is another beta blocker that has shown to not contribute to hyperglycemia because unlike most other beta blockers, carvedilol and nebivolol do not impair the release of insulin from the pancreatic B-cell (Rehman et al., 2011).
An important aspect to ensure that Susan is aware of, is the fact that beta blockers can cause issues in the control of her blood sugar with the possibility of hypoglycemia. By explaining to her that symptoms such as hunger, tremor, irritability and confusion can be masked by beta blockers, thus making it hard to discover low blood sugars, Susan can be made aware that checking her blood sugars is important and possibly the only way to catch hypoglycemia. Woo (2020) however, does mention that there are some hypoglycemic symptoms that are not masked by beta-blockers, such as diaphoresis, that should alert a patient to check their blood sugar when it occurs without explanation. This particular symptoms would be an important symptom for Susan to keep an eye out for since it is one of the only symptoms that will truly alert her to hypoglycemia. Since Susan has mentioned that she has not been hypoglycemic and that her blood sugars usually ranges from 60-80 mg/dL, it is also important to inform her that a level lower than 70 mg/dL in diabetics is considered hypoglycemic and should be addressed. Susan would need to be educated on what types of foods to consume and how much to consume if she were to ever need to address her hypoglycemia, which would include consuming 15 grams of carbs, such as half a cup of orange juice, to increase blood sugar immediately, followed by protein to stabilize the blood sugar.
Khalid, M.M., Galuska, M.A., & Hamilton, R.J. (2021). Beta-Blocker Toxicity. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK448097/ (Links to an external site.)
Majumdar, S.R. (1999). Beta-blockers for the treatment of hypertension in patients with diabetes: exploring the contraindication myth. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/10547224/
Mills, G.A. & Horn, J.R. (1985). Beta-blockers and glucose control. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/2861072/#:~:text=Ininsulindependentdiabeticsbeta,actionoforalhypoglycemicdrugs.
Pietrangelo, Ann (2019). Diabetes and Beta-Blockers: What You Need to Know. Retrieved from: https://www.healthline.com/health/diabetes/beta-blockers-what-you-need-to-know (Links to an external site.)
Rehman, A., Setter, S.M. & Vue, M.H. (2011). Drug-Induced Glucose Alterations Part 2: Drug-Induced Hyperglycemia. Retrieved from: https://spectrum.diabetesjournals.org/content/24/4/234
Woo, T. M. (2020). Pharmacotherapeutics for Advanced Practice Nurse Prescribers with 3-yr access to Davis Edge. [VitalSource Bookshelf]. Retrieved from https://online.vitalsource.com/#/books/9781719641531/
Discussion Prompt #2: Susan