Sign up for our complimentary
weekly e-journal

Main Newsletter
Mastery Series
Therapy Series
 
Bookmark and Share | Print Article | Test Your Knowledge Answers Previous | All Articles This Week | Next
This article originally posted 23 August, 2009 and appeared in  Issue 483

Test Your Knowledge Answer #483

Answer and Critique

Advertisement

(Correct Answer = D)

This patient's glycemic control is clearly suboptimal on his current treatment with glyburide and metformin; in fact, the latter drug is now contraindicated because the patient's serum creatinine concentration has exceeded 1.5 mg/dL (132.63 µmol/L) (1.4 mg/dL [123.79 µmol/L] in women). The most appropriate approach is to stop the metformin and glyburide and start insulin treatment. In this case, starting a premixed insulin such as 70% neutral protamine aspart–30% insulin aspart twice daily before breakfast and dinner is appropriate because his carbohydrate intake is consistent and his glucose pattern shows quite a narrow range of glucose levels without wide swings.

Continuing metformin and glyburide while adding basal insulin to his treatment or adding a premixed insulin before dinner and continuing his oral anti-diabetes medications would not be appropriate for the reasons listed above. In addition, substituting rosiglitazone for metformin is not likely to further lower the hemoglobin A1C value; if the patient were able to continue metformin, the addition of rosiglitazone would lower the A1C value by no more than 1.5 percentage points, which would not achieve the target of less than 7%.

Bibliography
  1. Yale JF, Valiquett TR, Ghazzi MN, Owens-Grillo JK, Whitcomb RW, Foyt HL. The effect of a thiazolidinedione drug, troglitazone, on glycemia in patients with type 2 diabetes mellitus poorly controlled with sulfonylurea and metformin. A multicenter, randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2001;134:737-45. [PMID: 11329231] [PubMed
Advertisement


 

Bookmark and Share | Print | Category | Home

This article originally posted 23 August, 2009 and appeared in  Issue 483

Past five issues: Issue 744 | Diabetes Clinical Mastery Series Issue 203 | Issue 743 | Diabetes Clinical Mastery Series Issue 202 | SGLT-2 Inhibitors Special Edition August 2014 |


Cast Your Vote
When Afrezza is available, will you prescribe it immediately or wait until it has been on the market for a while?
Search Articles On Diabetes In Control