托拉塞米致血糖升高1例

摘要

One 73-year-old female patient with type 2 diabetes mellitus and rheumatic heart disease was administrated torasemide (20 mg, tid) for half a month. Her fasting glucose rose up to 18 mmol·L-1, and torasemide was stopped, then the fasting blood glucose and postprandial blood glucose reduced to be about 10 mmol·L-1 and 15 mmol·L-1 respectively. After admission, the patient was given digoxin, warfarin, bisoprolol, sitagliptin, acarbose and subcutaneous injection of insulin detemir before sleep, after treatment for seven days, the fasting glucose and postprandial glucose was controlled at the range from 7.2 to 7.7 mmol·L-1 and from 10.3 to 11.3 mmol·L-1 respectively. The risk factors about diuretics-induced hyperglycemia are dosage, age, duration, and the original blood sugar levels. So clinical pharmacist suggest that type 2 diabetes patients, especially old patients, in the use of thiadiazide diuretics or loop diuretics, should start with the lowest dosage and monitor the potassium and blood sugar closely.%1例73岁女性患者,因2型糖尿病合并风湿性心脏病,加用托拉塞米(20 mg,tid),半个月后空腹血糖最高达18 mmol·L-1,停用托拉塞米,血糖有所下降,空腹血糖在10 mmol·L-1左右,餐后血糖在15 mmol·L-1左右.入院后继续服用抗心衰药、降糖药合并胰岛素治疗,7 d后,空腹血糖7.2~7.7 mmol·L-1,餐后血糖10.3~11.3 mmol·L-1,基本达标.利尿剂所致高血糖反应的危险因素主要与用药剂量、患者年龄、用药时间及原有血糖水平有关,建议2型糖尿病尤其是高龄患者在使用利尿剂时无论是噻嗪类还是髓袢利尿剂,应从小剂量起始,注意密切监测血钾、血糖水平.