Holding Glipizide When Not Eating

Yes, glipizide should be held if a patient is not eating to prevent hypoglycemia. 1

Rationale for Holding Glipizide

Sulfonylureas like glipizide have a long action and predispose patients to hypoglycemia when they are not consuming their normal nutrition, which serves as a relative contraindication to routine use in situations where patients are not eating 1
The mechanism of action of sulfonylureas stimulates insulin secretion regardless of blood glucose levels, creating a significant risk of hypoglycemia when carbohydrate intake is reduced or absent 1
For hospitalized patients, the use of sulfonylureas presents specific issues related to their predisposition to cause hypoglycemia in patients not consuming their normal nutrition 1

Elderly or debilitated patients are at higher risk for hypoglycemia when taking glipizide 2
Patients with renal impairment have a 4-fold increased risk of severe hypoglycemia with glipizide 3
Patients taking multiple medications (particularly diuretics and benzodiazepines) have increased risk of hypoglycemia 3
Fasting for tests or procedures significantly increases hypoglycemia risk in patients on sulfonylureas 1

According to the FDA label, glipizide should be given approximately 30 minutes before a meal to achieve the greatest reduction in postprandial hyperglycemia 2
Studies on similar sulfonylureas show that taking the medication without subsequent food intake results in poor glycemic control and increased hypoglycemia risk 4
When patients are not eating, the insulin secretion stimulated by glipizide is not balanced by carbohydrate intake, leading to potentially dangerous hypoglycemia 1

For patients who are NPO (nothing by mouth) or have reduced caloric consumption, hold glipizide to prevent hypoglycemia 1
For patients on insulin secretagogues like glipizide who are at risk of hypoglycemia, ensure they eat a source of carbohydrates at meals and do not skip meals 1
If a patient will be fasting for a procedure or test, hold the glipizide dose for that day 1
For hospitalized patients not eating normally, insulin therapy is preferred over sulfonylureas like glipizide due to its flexibility and opportunity for titration 1

Patients should be educated about times when they may be at increased risk for hypoglycemia, such as while fasting for tests, with delayed meals, or during periods of not eating 1
For patients who must temporarily stop eating due to illness or procedures, consider alternative diabetes management strategies that don't include sulfonylureas 1
Treatment of hypoglycemia requires ingestion of glucose or carbohydrate-containing foods, which may not be possible if the patient is NPO 1
Glucagon should be available for patients at increased risk for clinically significant hypoglycemia who cannot take oral carbohydrates 1

In elderly patients, the risk of hypoglycemia with sulfonylureas is particularly high, and treatment deintensification should be considered when eating patterns become inconsistent 1
For patients with chronic kidney disease, glipizide is the preferred sulfonylurea (if one must be used) as it does not have active metabolites, but should still be held if not eating 1
For hospitalized patients not eating, insulin therapy provides better flexibility than sulfonylureas for managing blood glucose 1