The concurrent use of ACE inhibitors and antidiabetics 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.
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