A 55-year-old man on a non-selective beta-blocker develops hypoglycemia. Which feature of his hypoglycemic episode is MOST likely to be masked by the beta-blocker?

• A Sweating
• B Hunger
• C Confusion
• D Tremor and palpitations ✓

Explanation

Beta-blockers block the adrenergic (beta-1 and beta-2 mediated) signs of hypoglycemia: tremor, palpitations, and tachycardia. Sweating is a cholinergic sympathetic response and is not blocked by beta-blockers — in fact it may be enhanced. Hunger and neuroglycopenic symptoms (confusion, weakness) are not adrenergically mediated and are therefore not masked. This means beta-blockers can dangerously obscure the warning signs that prompt the patient to seek glucose.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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