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Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office. Low blood sugar hypoglycemia can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, confusion, irritability, dizziness, or feeling shaky. Always keep a source of sugar with you in case you have low blood sugar.

Sugar sources include fruit juice, hard candy, crackers, raisins, and non-diet soda. Be sure your family and close friends know how to help you in an emergency. If you have severe hypoglycemia and cannot eat or drink, use a glucagon injection. Your doctor can prescribe a glucagon emergency injection kit and tell you how to use it. Also watch for signs of high blood sugar hyperglycemia such as increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, and weight loss.

Check your blood sugar carefully during times of stress, travel, illness, surgery or medical emergency, vigorous exercise, or if you drink alcohol or skip meals.

These things can affect your glucose levels and your dose needs may also change.

Make sure that you return to your doctor at least once a year more often if you are elderly or if your kidney function is at the limit of normal. This is the best way to tell if your diabetes is being controlled properly. Your doctor or diabetes educator will show you how and when to do this.

Carefully follow the advice from your doctor and dietician on diet, drinking alcohol and exercise. If you drink alcohol while taking Glucovance, you may get flushing, headache, breathing difficulties, rapid heart beat, stomach pains or feel sick and vomit. Do not use any other medicines containing metformin or glibenclamide, in the form of either a single or a combination product, while you are being treated with Glucovance. Taking additional metformin or glibenclamide-containing products may increase the risk of you getting unwanted side effects.

If you have to be alert, for example driving, be careful not to let your blood glucose levels fall too low. Low blood glucose levels may slow your reaction time and affect your ability to drive or operate machinery.

Drinking alcohol can make this worse. Protect your skin when you are in the sun, especially between 10 am and 3 pm. If you become sick with a cold, fever or flu, it is very important to continue eating your normal meals.

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Concurrent administration of metformin and cobicistat may increase the risk of lactic acidosis. Inhibition of MATE1 by cobicistat may decrease metformin eliminiation by blocking renal tubular secretion. New onset diabetes mellitus, exacerbation of diabetes mellitus, and hyperglycemia due to insulin resistance have been reported with use of anti-retroviral protease inhibitors. Atenolol: Beta-blockers can prolong hypoglycemia or can promote hyperglycemia. Temporal associations of atypical antipsychotic therapy with the aggravation of diabetes mellitus have been reported.

Patients taking sulfonylureas should be closely monitored for worsening glycemic control when an atypical antipsychotic is instituted. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin nicotinic acid is added or deleted to the medication regimen.

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Carbonic anhydrase inhibitors frequently decrease serum bicarbonate and induce non-anion gap, hyperchloremic metabolic acidosis. Use these drugs with caution in patients treated with metformin, as the risk of lactic acidosis may increase. Monitor electrolytes and renal function.

Acitretin: Retinoids have been reported to cause changes in blood sugar control in diabetics. In a study of 7 healthy male volunteers, acitretin treatment potentiated the blood glucose lowering effect of glibenclamide a sulfonylurea similar to chlorpropamide in 3 of the 7 subjects. Repeating the study with 6 healthy male volunteers in the absence of glibenclamide did not detect an effect of acitretin on glucose tolerance. Careful supervision of diabetic patients under treatment with acitretin is recommended, especially those taking concomitant sulfonylureas.

There appears to be no pharmacokinetic interaction between acitretin and glyburide.

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Nitazoxanide: The active metabolite of nitazoxanide, tizoxanide, is highly bound to plasma proteins. Caution should be exercised when administering nitazoxanide concurrently with other highly plasma protein-bound drugs with narrow therapeutic indices because competition for binding sites may occur.

Non-Ionic Contrast Media: Metformin and combination products containing metformin should be temporarily discontinued prior to the administration of iodinated radiopaque contrast agents. Lactic acidosis has been reported in patients taking metformin that experience nephrotoxicity after iodinated contrast media. Nonsteroidal antiinflammatory drugs: NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion.

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  • I always make sure to eat with my medication.

  • Any dosage adjustment requires a careful assessment of renal function.

  • Rare cases of severe hypoglycemia have been reported with concomitant use of quinolones and glyburide.

Hydroxychloroquine: Careful monitoring of blood glucose is recommended when hydroxychloroquine and antidiabetic agents, including metformin, are coadministered.

A decreased dose of the antidiabetic agent may be necessary as severe hypoglycemia has been reported in patients treated concomitantly with hydroxychloroquine and an antidiabetic agent.

Careful monitoring of blood glucose is recommended when hydroxychloroquine and antidiabetic agents, including sulfonylureas, are coadministered. Hydroxyprogesterone: Patients receiving antidiabetic agents like metformin should be closely monitored for signs indicating changes in diabetic control when therapy with progestins is instituted or discontinued.

Iloperidone: Patients taking sulfonylureas should be closely monitored for worsening glycemic control when an atypical antipsychotic is instituted.

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  • Monitor blood glucose when sparfloxacin and metformin are coadministered.

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