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Old 02-18-2012
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Drug Diabetes Mellitus Treatment

A 63 year woman with type 2 diabetes come to the physician for a follow up. She states that shes has attempted diet control and exercise for the last 11 months. She got a history of mild CHF, HTN, and hypertcholesterolemia; currently takes ramipril and aspirin and has NKDA. Lab studies show a creatinine of 2 mg/dl and Hb A1c of 9. Which of the following is the most appropriate treatment for this patient?

A- Glipizide
B- Insulin
C- Metformin
D- Metformin + Glipizide
E- Rosiglitazone
F- Acabose


I will apreciate your answer with clear explanation

Last edited by alfjof; 02-18-2012 at 06:08 PM.
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Old 02-18-2012
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ok i would say glipizide + metformin....

metformin is given to maintain weight. ( it increases sensitivity to insulin)
glipizide is a hypoglycemic which has hepatic metabolism only---> another way of stimulating more insulin production)

iono if the explanation makes sense.... literally just learned it and haven't really fully gotten the full spectrum yet
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Old 02-18-2012
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http://www.drugs.com/pro/glipizide-and-metformin.html

found this website just now....



this is why i love medicine... the discovery and hands on part.
hate sitting behind a desk only to be lectured by professors not enthusiastic to be there
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Remember in patient with impaired renal metformin is contraindicated, in this case SHE got a CREATININE 2mg/dl
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Old 02-18-2012
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Idea!

well i just read that glipizide is also contra in renal failure pts
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Old 02-18-2012
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Rosiglitazone?

its a thiazolindinedione which mechanism of action is to decrease hepatic gluconeogensis
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I believe E is not correct because the GLITAZONES DRUG cause weight again, in this case the patient have hypercholesterolemia
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Old 02-18-2012
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Acarbose.... because it is a glucose absorption inhibitor
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It use in combination with all them(insulin, sulfonylurea,etc) as montherapy; I cannot beleive the answer is Insulin
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Ruling out
C &D as Metformin is contraindicated in Renal dysfunction.

E. Rosiglitazone had CVS toxicity

F. Acarbose not used as monotherapy.

So it may be either Glipizide as it is the only sulfonyl urea safe to use in Renal dysfunction patient or Insulin.
I am inclined towards Glipizide since in Type 2 DM we start first with oral hypoglycemic drugs then shift to insulin
Btw whats the answer ??
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Not quite sure what the local guidelines are but glitazones will make sense to me given the patient profile highly suggestive of the so called "Metabolic Syndrome"; an insulin sensitizer could help.

Not a 100% though; tricky question.
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Old 02-19-2012
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In question they have clearly mentioned certain things which rule out the administration of certain drugs
Presence of CHF= so rosilglitazone can not be given as it can worsen it

Presence of Cr of 2 along with NKDA(non ketotoc diabetic acidosis)=can not give metformin(2 reason can cause lactic acidosis+excreted by kidney so can result in decrease excretion)

Now this leave 2 option glipizide and insulin
both are excreted by kidney so we have to be careful with administration as can lead to increase plasma level

Presence of NKDA favors use of INSULIN as we need to bring very high level of glucose to prevent him from entering into coma.Another reason according to me favoring use of INSULIN can be that the dosage of it can be controlled by us by external administration by increase or decreasing the rate according to hourly blood sugar level which can not be done with glipizide
I will go with B
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Quote:
Originally Posted by mohitkmc View Post
In question they have clearly mentioned certain things which rule out the administration of certain drugs
Presence of CHF= so rosilglitazone can not be given as it can worsen it

Presence of Cr of 2 along with NKDA(non ketotoc diabetic acidosis)=can not give metformin(2 reason can cause lactic acidosis+excreted by kidney so can result in decrease excretion)

Now this leave 2 option glipizide and insulin
both are excreted by kidney so we have to be careful with administration as can lead to increase plasma level

Presence of NKDA favors use of INSULIN as we need to bring very high level of glucose to prevent him from entering into coma.Another reason according to me favoring use of INSULIN can be that the dosage of it can be controlled by us by external administration by increase or decreasing the rate according to hourly blood sugar level which can not be done with glipizide
I will go with B
Gud explanation i did not laid importance on NKDA on treatment profile. Insulin and fluids are the treatment choice in this situation.
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  #14  
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Thank you all of you! that is the reason I like this forum. I'll post another one question soon
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Old 05-01-2013
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Default Diabetic Clinic in India

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For more information, Visit us at:
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