| Hypoglycaemia: all sulphonylurea drugs are capable of producing moderate or severe hypoglycaemia, particularly in the following conditions:- in patients controlled by diet alone,- in cases of accidental overdose,- when calorie or glucose intake is deficient,- in patients with hepatic and/or renal impairment; however, in long-term clinical trials, patients with renal insufficiency have been treated satisfactorily, using DIAMICRON® at reduced doses.In order to reduce the risk of hypoglycaemia it is therefore recommended:- to initiate treatment for non-insulin dependent diabetics by diet alone, if this is possible,- to take into account the age of the patient: blood sugar levels not strictly controlled by diet alone might be acceptable in the elderly,- to adjust the dose of DIAMICRON® according to the blood glucose response and to the 24 hour urinary glucose during the first days of treatment.Dosage adjustments may be necessary:- on the occurrence of mild symptoms of hypoglycaemia (sweating, pallor, hunger pangs, tachycardia, sensation of malaise). Such findings should be treated with oral glucose and adjustments made in drug dosage and/or meal patterns,- on the occurrence of severe hypoglycaemic reactions (coma or neurological impairment, see overdose), - loss of control of blood glucose (hyperglycaemia). When a patient stabilised on any diabetic regimen is exposed to stress such as fever, trauma, infection or surgery, a loss of control may occur. At such times, it may be necessary to increase progressively the dosage of DIAMICRON® and if this is insufficient, to discontinue the treatment with DIAMICRON® and to administer insulin. As with other sulphonylureas, hypoglycaemia will occur if the patients' dietary intake is reduced or if they are receiving a larger dose of DIAMICRON® than required.Care should be exercised in patients with hepatic and/or renal impairment and a small starting dose should be used with careful patient monitoring. | |