Treatment with Glimepiride must be initiated and monitored by a physician. The patient must take Glimepiride at the times and in the doses prescribed by the doctor, normally at the same time everyday. To achieve the goal of treatment of Glimepiride-optimal control of blood glucose-adherence to correct diet, regular and sufficient physical exercise and, if necessary, reduction of body weight are just as necessary as regular ingestion of Glimepiride.
Clinical signs of a still insufficiently lowered blood glucose (hyperglycaemia) are e.g. increased urinary frequency (polyuria), intense thirst, dryness of the mouth and dry skin. In the initial weeks of treatment, the risk of hypoglycemia may be increased and necessitates especially careful monitoring.
Factors Favoring Hypoglycaemia include: unwillingness or (more commonly in older patients) incapacity of the patient to cooperate; undernourishment, irregular meal times, or skipped meals; Imbalance between physical exertion and carbohydrate intake; Alteration of diet; Consumption of alcohol, especially in combination with skipped meals; Impaired renal function; Severe impairment of liver function; Overdosage with Glimepiride; Certain uncompensated disorders of the endocrine system affecting carbohydrate metabolism or counter-regulation of hypoglycaemia (as for example in certain disorders of thyroid function and in anterior pituitary or corticoadrenal insufficiency); Concurrent administration of certain other medicines (refer to interactions); Treatment with Glimepiride in the absence of any indication.
The patient must inform the physician about such factors and about hypoglycaemia episodes since they may indicate the need for particularly careful monitoring. If such risk factors for hypoglycaemia are present, it may be necessary to adjust the dosage of Glimepiride or the entire therapy. This also applies whenever illness occurs during therapy or the patient's life-style changes.
Those symptoms of hypoglycaemia which reflect the body's adrenergic counter-regulation (refer to Adverse Reactions) may be milder or absent where hypoglycaemia develops gradually, in the elderly and where there is autonomic neuropathy or where the patient is receiving concurrent treatment with beta-blockers, clonidine, reserpine, guanethidine or other sympatholytic drugs.
Hypoglycaemia can almost always be promptly controlled by immediate intake of carbohydrates (glucose or sugar, e.g. in the form of sugar lumps, sugar sweetened fruit juice or sugar sweetened tea). For this purpose patients must carry a minimum of 20 g of glucose with them at all times. They may require the assistance of other persons to avoid complications. Artificial sweeteners are ineffective in controlling hypoglycaemia. It is known from other sulfonylureas that despite initially successful counter measures, hypoglycaemia may recur. Patients must, therefore remain under close observation. Severe hypoglycaemia further requires immediate treatment and follow-up by a physician and in some circumstances in patients hospital care.
In exceptional stress situations (e.g. trauma, surgery, febrile infections) blood glucose regulation may deteriorate and a temporary change to insulin may be necessary to maintain good metabolic control.
Insulin in the treatment of choice for non-insulin-dependent diabetes mellitus (NIDDM) with renal and hepatic dysfunction. No experience has been gained concerning the use of Glimepiride in patients with impairment of liver function. In patients with severe impairment of renal function, change over to insulin is indicated, to achieve optimal metabolic control (see Contraindications).