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  #1  
Old 06-25-2011
mle2resident's Avatar
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Drug DM drug related question

A 54 year old man with type 2 DM comes to u for follow up. He also has a history of hypertension and mild CCF, for which he takes Enalapril and Asprin. He has been on diet and exercise to control his blood glucose. His lab tests show creatinine level 1.8 and HbA1c of 8.7%. Which medicine u would prescibe?

A. Glipizide
B. Insulin
C. Metformin
D. Continue diet and exercise.
E. Glipizide and Metformin.
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Old 06-25-2011
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I would say D.
since his has a history of CHF (glipizide is CI- cuz of rentention of fluids and edema- would make CHF worse) and increased creatinine level (meftormin- shouldn't be used in renal problems cuz of improper clearance of lactic acid which is increased with metformin use)
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Old 06-25-2011
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Insulin
as CCF and renal comprised state make other choices less likely
Diet and exercise in CCF patient is hard ( extreme workout is not possibe)
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Old 06-25-2011
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Originally Posted by dr pinky View Post
Insulin
as CCF and renal comprised state make other choices less likely
Diet and exercise in CCF patient is hard ( extreme workout is not possibe)
Im with you!
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Old 06-25-2011
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ir should be insulin...
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Old 06-25-2011
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Default Why not glipizide?

I think glipizide is SU drug, so don't cause fluid retention. Pioglitazone or rosiglitazone cause fluid retention. So I don't know why glipizide is bad choice.
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Old 06-25-2011
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Metformin is contraindicated in people approaching renal failure (subjectively above 1.7)

I'd push for Glipizide as the A1C is in that range - you could do insulin as well, but I think I'd stick with the 2G SU at this point
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Old 06-25-2011
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Quote:
Originally Posted by mle2resident View Post
A 54 year old man with type 2 DM comes to u for follow up. He also has a history of hypertension and mild CCF, for which he takes Enalapril and Asprin. He has been on diet and exercise to control his blood glucose. His lab tests show creatinine level 1.8 and HbA1c of 8.7%. Which medicine u would prescibe?

A. Glipizide
B. Insulin
C. Metformin
D. Continue diet and exercise.
E. Glipizide and Metformin.
i think its A. Glipizide?(OSU) and if its not helping, maybe switch to Insulin later??
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i think its A. Glipizide?(OSU) and if its not helping, maybe switch to Insulin later??
I think so too, but I'm not sure which is more inductive, Glipizide or insulin. Which is better choice for this patient?
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Old 06-25-2011
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this patient has renal failure...renal failure + OSU can cause severe hypoglycemia...

but in this case, maybe is the correct answer...

uptodate
"Thus, glipizide is the oral hypoglycemic drug of choice in patients with chronic renal failure. The dose for glipizide is 2.5 to 10 mg/day."

good question!

Last edited by bebix; 06-25-2011 at 09:01 PM. Reason: added info
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Old 06-26-2011
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Correct Answer A- Glipizide is the right answer.

Sulfonyl ureas, biguanides, alpha glucosidase inhibitors, glitazones and insulin are approved for monotherapy of diabetes.

However, Type 2 DM patients initially are started with sulfonyl ureas or biguanides. Insulin is given only when the oral agents fail to control blood glucose.

Glipizide, 2nd generation sulfony urea undergoes hepatic clearance, hence it can be safely used in pts with renal dysfunction.

Metformin is not given in renal dysfn. Rosiglitazone is not given as the pt has mild CCF.

Hence A is the right answer as most of u got it right.
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