Enalapril × Metformin

ACE inhibitors improve tissue insulin sensitivity and potentiate metformin's glucose-lowering effect. They do not cause hypoglycaemia alone but lower the threshold on insulin or sulfonylureas.

Signs of hypoglycaemia: sweating, tremor, hunger, tachycardia, confusion. Symptoms appear at glucose below 3.9 mmol/L.

On metformin alone, no dose adjustment needed. In patients on insulin or sulfonylureas, intensify glucose self-monitoring for the first 2 weeks after starting enalapril. The effect is helpful in type 2 diabetes with arterial hypertension.