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?
Select one answer:
Answer: A - Discontinue the glyburide
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.
Inzucchi S, et al. Management of hyperglycemia in type 2 diabetes: A patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012; 35(6):1364-1379.
Cheng A. The rules of 3's: Insulin use in type 2 diabetes. Canadian Diabetes Association. Available at http://www.diabetes.ca/documents/for-professionals/CD--Spring_2011--A.Cheng_.pdf. Published Spring 2011. Accessed Oct. 17, 2012.