glyburide Nursing Considerations & Management

 Drug Name

Generic Name : glyburide

Brand Name: DiaBeta, Euglucon (CAN), Gen-Glybe (CAN), Glibenclamide, Glynase PresTab, Micronase, ratio-Glyburide (CAN)

Classification: Antidiabetic, Sulfonylurea

  • Pregnancy Category B (Micronase, Glynase)
  • Pregnancy Category C (DiaBeta)
Dosage & Route
  • Available forms : Tablets—1.25, 2.5, 5 mg; micronized tablets—1.5, 3, 4.5, 6 mg
ADULTS
  • Initial therapy: 2.5–5 mg PO with breakfast (DiaBeta, Micronase); 1.5–3 mg/day PO (Glynase).
  • Maintenance therapy: 1.25–20 mg/day PO given as a single dose or in divided doses. Increase in increments of no more than 2.5 mg at weekly intervals based on patient’s blood glucose response (DiaBeta, Micronase); 0.75–12 mg/day PO (Glynase).
PEDIATRIC PATIENTS
  • Safety and efficacy not established.
GERIATRIC PATIENTS
  • Geriatric patients tend to be more sensitive to the drug; start with initial dose of 1.25 mg/day PO (DiaBeta, Micronase) 0.75 mg/day PO (Glynase). Monitor for 24 hr, and gradually increase dose after at least 1 wk as needed.
Therapeutic actions
  • Stimulates insulin release from functioning beta cells in the pancreas; may improve binding between insulin and insulin receptors or increase the number of insulin receptors; more potent in effect than first-generation sulfonylureas.
Indications
  • Adjunct to diet to lower blood glucose with type 2 diabetes mellitus
  • Adjunct to metformin when adequate results are not achieved with either drug alone
  • Adjunct to insulin therapy in the stabilization of certain cases of type 2 diabetes mellitus, reducing the insulin requirement, and decreasing the chance of hypoglycemic reactions
Adverse effects
  • CNS: Drowsiness, tinnitus, fatigue, asthenia, nervousness, tremor, insomnia
  • CV: Increased risk of CV mortality
  • Endocrine: Hypoglycemia
  • GI: Anorexia, nausea, vomiting, epigastric discomfort, heartburn, diarrhea, weight gain
  • Hematologic: Leukopenia, thrombocytopenia, anemia
  • Hypersensitivity: Allergic skin reactions, eczema, pruritus, erythema, urticaria, photosensitivity, fever, eosinophilia, jaundice
Contraindications
Glyburide tablets are contraindicated in patients with:
  1. Known hypersensitivity or allergy to the drug.
  2. Diabetic ketoacidosis, with or without coma. This condition should be treated with insulin.
  3. Type I diabetes mellitus, as sole therapy.
Nursing considerations
CLINICAL ALERT! Name confusion has occurred between DiaBeta (glyburide) and Zebeta (bisoprolol); use caution.
Assessment
  • History: Allergy to sulfonylureas; diabetes with complications; type 1 diabetes, serious hepatic or renal impairment, uremia, thyroid or endocrine impairment, glycosuria, hyperglycemia associated with primary renal disease, pregnancy
  • Physical: Skin color, lesions; T; orientation, reflexes, peripheral sensation; R, adventitious sounds; liver evaluation, bowel sounds; urinalysis, BUN, serum creatinine, LFTs, blood glucose, CBC
Interventions
  • Give drug before breakfast. If severe GI upset occurs, dose may be divided and given before meals.
  • Monitor urine or serum glucose levels frequently to determine drug effectiveness and dosage.
  • Monitor dosage carefully if switching to or from Glynase.
  • WARNING: Transfer to insulin therapy during periods of high stress (eg, infections, surgery, trauma).
  • WARNING: Use IV glucose if severe hypoglycemia occurs as a result of overdose.
Teaching points
  • Do not discontinue this medication without consulting your health care provider.
  • Monitor urine or blood for glucose and ketones.
  • Do not use this drug during pregnancy; consult health care provider.
  • Avoid alcohol while using this drug.
  • Report fever, sore throat, unusual bleeding or bruising, rash, dark urine, light-colored stools, hypoglycemic or hyperglycemic reactions.