Oral antidiabetics and corticosteroids

Endocrine drug stems split into insulin emergencies and everything else that still moves glucose and cortisol. DKA, HHS, and insulin peaks live in Diabetes and glycemic emergencies. Addison versus Cushing disease pictures live in Thyroid and adrenal disorders. This chapter owns oral/non-insulin antidiabetics and corticosteroid therapy teaching.

Oral and non-insulin antidiabetics

Type 2 regimens often start with drugs that cut hepatic glucose output, squeeze out insulin, incretin pathways, or spill glucose in urine. Your exam job is matching class to the danger: who hypoglycemias, who fails with bad kidneys, who needs holding for contrast or surgery.

Metformin safety

Metformin does not usually cause hypoglycemia alone, which is why stems love it as the “safe sugar drug” — until kidneys or contrast enter the story. Iodinated contrast and acute kidney injury raise lactic acidosis risk in vulnerable clients. Hold around contrast per protocol, check restart rules after creatinine clears, and teach clients not to restart on their own after a scan. Report unusual muscle pain, profound malaise, or unexplained hyperventilation patterns — rare, but the exam still asks.

Drugs that can cause hypoglycemia

Sulfonylureas (and mealtime meglitinides) push insulin out whether food arrives or not. Pair teaching with the same hypo recognition used for insulin: shake, sweat, confusion, treat with fast carbohydrate if safe to swallow. Elders and clients with irregular meals are classic miss stems. Alcohol without food stacks the hypo risk.

1. Know which drug can cause hypo before the meal tray is late.
2. Hold metformin per contrast/renal protocol — document the hold.
3. Sick-day rules still apply: check glucose, hydrate, know when to call.
4. SGLT2: genital hygiene, hold in acute illness/surgery as ordered, watch for dehydration.

Corticosteroids

Glucocorticoids (prednisone, methylprednisolone, dexamethasone, and kin) are anti-inflammatory and immunosuppressive. They also raise blood glucose by opposing insulin, so diabetics need more monitoring and often more antidiabetic therapy while on steroids. Infection risk rises — fever is a call-now finding, not a shrug. Skin thins, wounds slow, mood can lift or crash, appetite and sodium retention climb, and long-term use risks osteoporosis and adrenal suppression.

Why abrupt stop is dangerous: chronic exogenous steroid tells the adrenal glands to nap. Remove the drug suddenly and the client cannot make enough cortisol for stress — weakness, hypotension, nausea, and shock risk. Taper schedules exist to wake the axis gradually. Stress dosing during illness or surgery follows the endocrine plan, not a guess.

Administration tips that appear on exams: give in the morning when ordered to mimic diurnal rhythm and reduce insomnia, take with food if GI upset, never share doses, and carry medic-alert if adrenal-dependent. Topical and inhaled steroids have less systemic load but still need technique teaching (rinse after inhaled steroids to cut thrush) — systemic stems are where glucose and taper rules dominate.

• Live vaccines may be restricted on significant immunosuppression — follow orders (see Immunisation and HIV).
• Blood pressure and weight trends catch fluid retention.
• Link back to Addison crisis teaching if the client is steroid-dependent.

Priority map