The concurrent use of ACE inhibitors
normally appears to be uneventful. However, hypoglycaemia, marked in some instances, has occurred in a small number of diabetics taking insulin or sulphonylureas with captopril
, enalapril, lisinopril
or perindopril. This has been attributed, but not proven, to be due to an interaction.
This interaction remains the subject of considerable study and debate. It would be prudent to warn all patients taking insulin or oral antidiabetics
who are just starting any ACE inhibitors
that excessive hypoglycaemia has been seen very occasionally and unpredictably. It may be prudent to temporarily increase the frequency of blood glucose monitoring. The problem has been resolved in some patients by reducing the sulphonylurea dosage.