Complications go beyond co-morbidities for blind diabetes patient…
At our VA hospital, I had been treating a 62-year-old legally blind veteran patient for diabetes. At first, he had not been very compliant with an A1C of 9% while on glipizide 10 mg bid, but then did very well when I added metformin to his regimen. He began walking on his home treadmill and began carb-counting. When I saw him back in the office for his 3 month follow-up, he had lost 15 pounds and his A1C had decreased to 6.9% and renal function was normal. He was only checking fasting blood sugars, which ranged 80-110.
From our comprehensive electronic medical records, I noticed that he had been to the Emergency Room 9 days before for a urinary tract infection and was given a 10 day course of ciprofloxacin. I was aware that ciprofloxacin can potentiate glipizide to increase the risk of hypoglycemia. The patient commented that he had never experienced hypoglycemia. His “caregiver girlfriend” was with him. We discussed symptoms and glucose parameters. I suggested they monitor all pre-meal and bedtime readings to make sure he was not going too low. I also advised that he decrease his glipizide to 5 mg bid through the next day until off the ciprofloxacin but he declined, stating that he did not see the need because he had not had a low thus far and he did not want his A1C going higher since he had worked so hard to get it down.
Unfortunately, the very next day (the last day of ciprofloxacin and a Friday), my patient skipped lunch and took a nap. By 4 PM, his caregiver girlfriend called police when the patient began “acting strange.” The patient became belligerent and refused to let the policemen in. The police forced entry and began beating the patient. By this time, the caregiver girlfriend finally realized that the patient was having a hypoglycemic reaction. She informed the police of this and informed them that patient was legally blind and did not know what was occurring, but the police continued to beat the patient until they could handcuff him. The patient was wearing a medic alert necklace. The caregiver girlfriend then called the emergency medical system, which treated the patient for a glucose of 26. The patient was taken to the county hospital for x-rays to rule out fractures and then to the county jail where he spent the weekend until he could post bail. The patient had no idea what had happened to him.
Due to the interaction of ciprofloxacin potentiating the effects of glipizide plus omitting a meal, the patient had incurred severe hypoglycemia. It is imperative to monitor glucose readings closely when taking non-diabetes medication that can interact with diabetes medication.
I treated the patient for his wounds from the beating, filed an internal adverse drug reaction report, again advised the patient to cut his glipizide in half. I wrote a letter to the judge on the patient’s behalf, explaining that the patient’s behavior was due to acute neurological impairment from lack of glucose to the brain complicated by his distorted perception of being legally blind. I wanted to contact the police chief to ask if his force could be better trained on recognizing hypoglycemic symptoms (especially with diabetic patients wearing medic alert identification) but my patient asked that I refrain until his legal issues were resolved.
Four thousand dollars and 6 months later, the charges from this unfortunate situation were dropped.
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