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August 9, 2003

Daily Care, Type 2

Question from Louisiana, USA:

If an adult patient with type 2 diabetes who is taking glipizide came to you after two weeks and the blood sugar level was still not well controlled, would the next step be to Increase the dose of glipizide, replace with insulin. or replace with metformin?


It depends. and I don’t have enough information. I would need to know the person’s age, height and weight, duration of diabetes, blood sugar levels fasting, along with before and after meals, the current dose of glipizide, and their liver and kidney function. All of these factors as well as dietary and activity habits help me decide which would be the best course of action.

Additional comments from Barb Schreiner, diabetes nurse specialist:

Maximize the dose of glipizide, and then add metformin a few weeks later. DeFronzo and others have recommended not stopping one drug and starting another. Rather, use combination therapy with drugs from different classes.