Monday , October 23 2017
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Medication Modification

One of your patients is currently taking metformin, glyburide, and an evening basal dose of insulin. After discussing how best to achieve better glycemic control, he has agreed to add a pre-meal insulin dose. Which modification should be made with the addition of the prandial dose?

Correct

Correct Answer: A. Discontinue the glyburide

Educational Critique: Secretagogues should be discontinued with the addition of a prandial insulin dose. The secretagogues may be useful in conjunction with basal insulin by providing some protection against initial glycemic control deterioration. However, after insulin dosing is stabilized, even if the secretagogues do not provide any additional benefit on A1C reduction, their discontinuation will help decrease the risk of hypoglycemia or weight gain.

Incorrect

Correct Answer: A. Discontinue the glyburide

Educational Critique: Secretagogues should be discontinued with the addition of a prandial insulin dose. The secretagogues may be useful in conjunction with basal insulin by providing some protection against initial glycemic control deterioration. However, after insulin dosing is stabilized, even if the secretagogues do not provide any additional benefit on A1C reduction, their discontinuation will help decrease the risk of hypoglycemia or weight gain.