Losartan × Metformin

ARBs, like ACE inhibitors, improve tissue insulin sensitivity. In patients on insulin or sulfonylureas with metformin, the glucose-lowering effect may be amplified.

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

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