December 31, 2005
Hyperglycemia and DKA, Pills for Diabetes
Question from Gujarat, India:
I have a patient who has had type 2 diabetes for four years. He is taking one glibenclamide, 5 mg, twice daily; one glimepride 2 mg, twice daily; one pioglitazone 30 mg, twice daily; and one metformin, 1000 mg, twice daily. His postprandial blood sugar averages 310 mg/dl [17.2 mmol/L]. He is not willing to take insulin. Is there another combination of pills he can take?
Answer:
This patient has very high post-meal blood sugars and requires insulin for adequate treatment. They are already being treated with all the major oral agents. There is really no additional medication to turn to that will help. The new medication, exenatide, is recommended for those who fail sulfonylurea and metformin. This might be a consideration. However, it also requires subcutaneous injections twice a day. It would have the advantage of improving the post-meal insulin response.
JTL
