DRUGS FOR DIABETES
□ Insulin resistance occurs in type 2 diabetes. Which ethnic groups are at higher risk for developing insulin resistance?r -
... [Show More] ANSWER-- African Americans
- Asian Americans
- Mexican Americans
DRUGS FOR DIABETES
□ In patients with insulin resistance, the insulin levels are (increased or decreased)? - ANSWER-Increased
DRUGS FOR DIABETES
□ What does hyperinsulinemia do to the body? - ANSWER-- Increases smooth muscle proliferation
- increases angiotensin II
- enhances sympathetic activation
DRUGS FOR DIABETES
□ Sustained hyperglycemia, polyuria, polydipsia, ketonuria, and weight loss are clinical signs of____________? - ANSWER-Diabetes mellitus (DM)
DRUGS FOR DIABETES
□ What is the skin manifestation that may be present with DM? - ANSWER-Acanthosis nigricans
DRUGS FOR DIABETES
□ How is DM diagnosed? - ANSWER-- Fasting blood sugar > or equal to 126 mg/dL or random check > 200 mg/dL.
- HbA1c > 6.5
DRUGS FOR DIABETES
□ What are some of the risk factors for DM? - ANSWER-- overweight (BMI > 25 kg/m2)
- inactive
- have a first-degree relative with DM
- in a high-risk race/ethnic groups
- have had gestational DM
DRUGS FOR DIABETES
□ Patients without risk factors for DM should be screened starting at age_____? - ANSWER-45
DRUGS FOR DIABETES
□ Name some medications that can elevate blood glucose levels and
increase the risk of DM: (5) - ANSWER-- antipsychotics
- glucocorticoids
- statins
- sympathomimmetics
- thiazide diuretics
DRUGS FOR DIABETES
□Women with polycystic ovarian syndrome are at risk of developing____? - ANSWER-DM
DRUGS FOR DIABETES
□ Glucose interacts spontaneously with Hbg in RBCs to form glycated derivatives that can be measured in the blood.
What is the name of this test that serves as an index of average glucose levels over the prior 2-3 months? - ANSWER-Glycosylated hemoglobin (HbA1C)
□ What level of HbA1c is considered "prediabetes" or impaired fasting glucose (IFG?) - ANSWER-5.7-6.4%
(According to the 2015 AACE/ACE Guideline HbA1c of 5.5% is considered prediabetes)
DRUGS FOR DIABETES
□ Why is the term "prediabetes" preferred rather than impaired fasting glucose or impaired glucose tolerance or borderline diabetes? - ANSWER-Patients are more inclined to initiate self-care when their condition is called "pre-diabetes" and are at risk for developing DM
□ What is the recommended treatment for patients with prediabetes? - ANSWER-TLC.
- Pharmacotherapy can be initiated in patients with high risk of developing DM
DRUGS FOR DIABETES
□ What is the target value HbA1C for patients with diabetes? - ANSWER-Less than 7% (ADA)--- Ideal is 6.5% (AACE). I
- Important new research indicates that tight glucose control in some individuals can be detrimental. Patients should be treated as individuals.
DRUGS FOR DIABETES
□ Name some situations in which the goal HbA1c may be as high as 8%. - ANSWER-- patients with a history of severe hypoglycemia
- limited life expectancy
- advanced renal or macrovascular complications
- extensive comorbid conditions
- long-standing DM in which the A1C goal have
been difficult to attain.
DRUGS FOR DIABETES
□ What is SMBG? - ANSWER-S_elf M_onitoring B_lood G_lucose
DRUGS FOR DIABETES
□ Patients with normal fasting blood sugar may have
elevated bA1c levels because of elevations of___________________? - ANSWER-Post prandial glucose
DRUGS FOR DIABETES
□ Which measure of glycemic control becomes elevated first in most patients with DM -the fasting or post prandial glucose? - ANSWER-Post prandial
DRUGS FOR DIABETES
□ What is the target post prandial glucose (2 hours after the start of a meal) in patients with DM? - ANSWER-< 140 mg/dL (AACE) < 180 mg/dL (ADA)
DRUGS FOR DIABETES
□ Which medications target post
prandial glucose elevations? - ANSWER-- metformin
- meglitinides
- alpha glucosidase inhibitors
- incretin enhancers
□ What is the purpose of measuring C-peptide levels in patients with diabetes? - ANSWER-Normal C-peptide levels indicate that the pancreas is producing insulin.
DRUGS FOR DIABETES
□ What kinds of conditions interfere with the HbA1c assay? - ANSWER-- sickle cell trait
- anemia
- alterations in red cell function
- acute blood loss
- chronic renal failure
- Ethnic groups from Africa, Mediterranean, and Southeast Asia may have alterations in red cell function that alter HbA1c assay
□ In diabetic ketoacidosis (DKA), the body breaks down fat to produce___________? - ANSWER-Ketoacids
DRUGS FOR DIABETES
□ Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) results in dehydration and hemoconcentration and is more common in patients with (Type 1 or Type 2 diabetes)? - ANSWER-Type 2-Acidosis and ketosis does not occur
DRUGS FOR DIABETES
□ What is the treatment of diabetic ketoacidosis (DKA)? - ANSWER-Fluid and electrolyte replacement and regular insulin given IV.
DRUGS FOR DIABETES
□ Are patients with diabetes more susceptible to depression? - ANSWER-Yes, make sure you screen and treat to enhance diabetes self-management
DRUGS FOR DIABETES
□ Which agent for depression can also be beneficial for patients with diabetic peripheral neuropathy? - ANSWER-Duloxetine (Cymbalta) has indications for diabetic peripheral neuropathy.
- Inhibition of norepinephrine (NE) reuptake allows for more NE at nerve terminals and is thought to have a role in reducing the neuropathic pain of diabetic peripheral neuropathy
DRUGS FOR DIABETES
□ Are patients with gestational diabetes at higher risk for diabetes later in life? - ANSWER-Yes
DRUGS FOR DIABETES
□ Do oral agents for diabetes cross the placenta? - ANSWER-Yes and the effect on the fetus is not certain. Metformin is often used
DRUGS FOR DIABETES
□ What is the goal BP for a patient with DM according to JNC- 8? - ANSWER-140/90 mm Hg
Some organizations prefer 135/80 mm/Hg
DRUGS FOR DIABETES
□ What is the goal LDL level for a patient with DM according to the newest cholesterol guidelines? - ANSWER-- LDL levels should be reduced by 50%
- use moderately intense statins per the ACC/AHA - keep LDL < 70 mg/dL according to the National Lipid Association
DRUGS FOR DIABETES
□ How should lipids be managed in patients with prediabetes? - ANSWER-Because macrovascular disease may be evident prior to the diagnosis of DM.
- lipid levels of patients with prediabetes should be managed in the same manner as those of patients with DM
DRUGS FOR DIABETES
□ Name a lipid lowering drug that is approved for diabetes and lowers HbA1c - ANSWER-Colesevelam (Welchol)
- which is a bile acid sequestrant
DRUGS FOR DIABETES
□ What are the components of the metabolic syndrome? - ANSWER-1) Abdominal obesity-waist > 40 inches for men
and 35 inches for women
2) High TG greater than 150 mg/dL
3) Low HDL below 40 mg/dL in men and 50 mg/dL
in women
4) Hyperglycemia FBS greater than 100 mg/dL
5) High blood pressure 130/85 or undergoing drug
therapy for HTN
DRUGS FOR DIABETES
□ Why are the triglycerides often elevated in patients with uncontrolled DM? - ANSWER-Fatty acids are broken down when the body is unable to metabolize glucose properly, because of insulin deficiency or insulin resistance
DRUGS FOR DIABETES
□ A patient with diabetes has microalbuminuria (albumin in the urine).
Which antihypertensive agent should be started to decrease kidney damage? - ANSWER-ACE inhibitor or ARB
INSULIN THERAPY
□ What type of therapy lowers the HbA1c the most in patients with DM? - ANSWER-Insulin
INSULIN THERAPY
□ What type of insulin is recommended as the initial choice in patients with DM - ANSWER-Long-acting basal insulin should be the initial choice in most cases
INSULIN THERAPY
□ A patients will most likely require insulin at the initial presentation when the HbA1c is >______% - ANSWER-9%
INSULIN THERAPY
□ Do patients feel better after starting insulin? - ANSWER-Yes!
- They often don't realize how poorly they felt when the blood sugar was elevated.
INSULIN THERAPY
□ A patient presents to the clinic with a blood sugar of 240 mg/dL because they ran out of their oral agents.
Why is it important to prescribe a 2-3 week course of insulin therapy? - ANSWER-Glucose toxicity occurs and oral medications are not absorbed as well in the hyperglycemic state
INSULIN THERAPY
□ When do you discontinue the oral agents when insulin is initiated? - ANSWER-When they are no longer effective, usually when mealtime insulin is needed
INSULIN THERAPY
□ Should you discontinue the
metformin when insulin is initiated? - ANSWER-- Many providers consider the metformin helpful to decrease the amount of insulin needed by decreasing insulin resistance and continue using the metformin.
- Metformin is also used in patients with type 1 DM if they are overweight and likely have insulin resistance
INSULIN THERAPY
□ Why should insulin be administered at room temperature? - ANSWER-Insulin injected is better absorbed at room temperature rather than given cold
INSULIN THERAPY
□ Once the insulin vial is opened, it can be stored at room temperature for________? - ANSWER-One month.
- Be aware that in Florida, it is best to keep opened and unopened vials in the refrigerator. Insulin is very easily broken down in higher ambient temperatures.
- Warm the pen or syringe by rolling with the hands to bring it to room temperature for administration. Insulin injected cold, is not absorbed as well.
INSULIN THERAPY
□ How can lipohypertrophy (accumulation of subcutaneous fat at sites of frequent insulin injection) be avoided? - ANSWER-With systematic rotation of injection sites.
- Absorption of insulin is diminished in areas of lipohypertrophy. Check patients for this complication
INSULIN THERAPY
□ If a patient injects Regular insulin and then eats breakfast, when would you be worried about hypoglycemia? - ANSWER-Before lunch when the insulin is at its peak
Onset: 30-60min
Peak: 1-5hrs
Duration: 6-10hrs
INSULIN THERAPY
□ Which types of insulin are always cloudy? - ANSWER-NPH and any type of pre-mix (70/30 or 75/25) that contains NPH.
INSULIN THERAPY
□ Why is it important to gently agitate NPH insulin prior to administration? - ANSWER-To disperse the particles in suspension
INSULIN THERAPY
□ Why is it important to draw regular insulin up first when combinations of insulin are used? - ANSWER-The NPH will inactivate or contaminate the rapid acting insulin.
INSULIN THERAPY
□ What is the definition of 'basal" insulin? - ANSWER-The small amount of insulin that the pancreas produces to keep the blood sugar normal in between meals
INSULIN THERAPY
□ What portion of the total daily dose is the basal requirement? - ANSWER-50%
INSULIN THERAPY
□ Which insulins are considered long acting or basal insulins? - ANSWER-- Insulin glargine (Lantus)
- insulin detemir (Levemir) ---> at higher doses
INSULIN THERAPY
□ Why is basal insulin given at night? - ANSWER-It can be given every 24 hours and night time seems to be convenient because there is no mealtime insulin injection before bed.
- It can be given at other times and it can be given BID.
-After dinner is convenient because sometimes patients fall asleep and forget to inject at HS.
INSULIN THERAPY
□ Which of the basal insulins has the longest duration? - ANSWER-Insulin glargine (Lantus) was once the longest acting.
- Currently there are 3 "super-long acting" basal insulins on the market.
INSULIN THERAPY
□ Is insulin detemir (Levemir) considered a long acting or intermediate acting insulin? - ANSWER-Long Acting Insulin
- at higher doses (0.4 units/kg) it has a duration of 20-24 hours
INSULIN THERAPY
□ How do you calculate the total daily dose (TDD) of insulin? - ANSWER-0.5 units/kg/day is a good start for many patients.
- The range is 0.3-0.8 mg/kg/day
INSULIN THERAPY
□ How do you calculate basal insulin needs? - ANSWER-½ of the TDD
INSULIN THERAPY
□ Is NPH considered a basal insulin? - ANSWER-No
INSULIN THERAPY
□ How often is NPH injected? - ANSWER-Every 12 hours
INSULIN THERAPY
□ Why are basal insulins preferred over NPH? - ANSWER-The risk of hypoglycemia is higher with NPH
INSULIN THERAPY
□ How many units of insulin are in one ml of U100 insulin? - ANSWER-Each ml contains 100 units of insulin
INSULIN THERAPY
□ How are mixed insulins such as 70/30 combinations given? - ANSWER-- 2/3 of the TDD in the am before breakfast
- 1/3 before dinner
INSULIN THERAPY
□ Can you give 70/30 combinations at HS? - ANSWER-No, they need to be given with a meal
INSULIN THERAPY
□ Why are basal insulins preferred over 70/30 combinations? - ANSWER-They have reduced flexibility and higher risk of hypoglycemia
INSULIN THERAPY
□ Name the newer rapid acting insulins that have an earlier onset of action than regular insulin and need to be injected 10-30 minutes prior to eating. - ANSWER-- insulin lispro (Humalog)
- insulin aspart (Novo Log)
- insulin glulisine (Apidra)
INSULIN THERAPY
□ What is the onset of action of insulin aspart (Novo Log) - ANSWER-10-20 minutes
INSULIN THERAPY
□ When does insulin aspart
(Novo Log) peak? - ANSWER-Peaks --> 1-3 hrs
- with an onset and duration of:
Onset--> 10-20min
Duration--> 3-5hrs
INSULIN THERAPY
□ How long does of insulin Aspart (Novo Log) last? - ANSWER-3-5 hours
INSULIN THERAPY
□ How do you calculate mealtime dosage or bolus insulin? - ANSWER-½ of the TDD split among the 3 meals
INSULIN THERAPY
□ How is mealtime dosage of insulin adjusted? - ANSWER-Postprandial blood sugar (2 hours after the start of the meal) should be about 140 mg/dL
INSULIN THERAPY
□ A simple method of calculating insulin needed to cover carbohydrate ingestion is that 2 units of rapid acting insulin is needed for every__________grams of carbohydrates. - ANSWER-15
INSULIN THERAPY
□ If a patient with Type 2 diabetes plans on consuming 15 grams of carbohydrates, they will need to inject____________units of rapid acting insulin. - ANSWER-2
INSULIN THERAPY
□ If a patient with Type 2 diabetes plans on consuming 45 grams of carbohydrates, they will need to inject____________units of rapid acting insulin. - ANSWER-6
INSULIN THERAPY
□ If a patient with Type 2 diabetes plans on consuming 105 grams of carbohydrates, they will need to inject____________units of rapid acting insulin. - ANSWER-14
INSULIN THERAPY
□ How many grams of carbohydrates in 16 ounces of Coca Cola? - ANSWER-40 grams!
INSULIN THERAPY
□ What is the problem with insulin sliding scales? - ANSWER-It treats hyperglycemia after it has already occurred
INSULIN THERAPY
□ Can you mix insulin glargine (Lantus) with rapid acting insulins? - ANSWER-No
INSULIN THERAPY
□ What types of insulin are given IV? - ANSWER-Mostly regular insulin.
- The insulin analogs are approved for IV use
INSULIN THERAPY
□ What is the most important complication from insulin treatment? - ANSWER-Profound hypoglycemia
HYPOGLYCEMIA & HYPERGLYCEMIA
□ What are the clinical signs of hypoglycemia? - ANSWER-- Tachycardia
- palpitations
- diaphoresis
- nervousness
- fatigue
- headache
HYPOGLYCEMIA & HYPERGLYCEMIA
□ Which condition is more threatening, hypoglycemia or hyperglycemia? - ANSWER-Hypoglycemia is especially problematic-caution with older individuals and those with ASCVD
HYPOGLYCEMIA & HYPERGLYCEMIA
□ Should HbA1c goal be the same for patients with heart disease? - ANSWER-No.
-hypoglycemia can cause cardiovascular death
HYPOGLYCEMIA & HYPERGLYCEMIA
□ Which special groups of patients might not need extensive lowering of HbA1c? - ANSWER-- older adults
- children
- adolescents
- those with ASCVD disease
HYPOGLYCEMIA & HYPERGLYCEMIA
□ Which class of drugs masks the hypoglycemic events by suppressing tachycardia and palpitations? - ANSWER-Beta blockers
HYPOGLYCEMIA & HYPERGLYCEMIA
□ In what ways can beta blockers be helpful in patients with DM? - ANSWER-Beta blockers decrease the SNS stimulation that goes along with DM.
- They are sometimes used in spite of their adverse effects of decreasing the s/s of hypoglycemia
HYPOGLYCEMIA & HYPERGLYCEMIA
□ What is the treatment for insulin overdose? - ANSWER-IV dextrose or glucagon
HYPOGLYCEMIA & HYPERGLYCEMIA
□ Why is it important to place an individual on their side after the administration of glucagon for hypoglycemia? - ANSWER-Nausea and vomiting can occur after receiving glucagon
□ What level of blood glucose is considered hypoglycemia? - ANSWER-70 mg/dL or if the patient is symptomatic
HYPOGLYCEMIA & HYPERGLYCEMIA
□ A patient presents to the clinic with a blood sugar of 300 mg/dL and insulin is initiated. The patient calls to c/o symptoms of hypoglycemia with a blood sugar of 150 mg/dL. Is this possible? - ANSWER-Yes, listen to the patient
HYPOGLYCEMIA & HYPERGLYCEMIA
□ A patient on insulin becomes groggy and you suspect that they are experiencing hypoglycemia. What should you check before giving 4 ounces of orange juice? - ANSWER-The gag reflex
HYPOGLYCEMIA & HYPERGLYCEMIA
□ Can milk be used to reverse hypoglycemic s/s? - ANSWER-Yes, 8 ounces of milk is effective and will not cause the blood sugar to rise as high as orange juice and is preferred
HYPOGLYCEMIA & HYPERGLYCEMIA
□ What can happen when a patient taking insulin or a secretagogue drinks alcohol? - ANSWER-Delayed hypoglycemia
HYPOGLYCEMIA & HYPERGLYCEMIA
□ What is the Somogyi phenomenon (rebound hyperglycemia)? - ANSWER-Hyperglycemia following an episode of nocturnal hypoglycemia
HYPOGLYCEMIA & HYPERGLYCEMIA
□ What is the cause of the rebound hyperglycemia with the Somogyi phenomenon? - ANSWER-Hypoglycemia episode leads to release of counter-regulatory hormones (epinephrine, cortisol, & growth hormone) and stored glucose in the liver
HYPOGLYCEMIA & HYPERGLYCEMIA
□ What is the Dawn phenomenon? - ANSWER-Fasting hyperglycemia due to increases in growth hormone in the dawn hours
HYPOGLYCEMIA & HYPERGLYCEMIA
□ Morning hyperglycemia may be due to Somogyi or Dawn phenomenon. How can the two problems be distinguished? - ANSWER-Check the 3:00 AM glucose (BgL < 60 at 03:00).
Somogyi Phenomenon - hyperglycemia following an episode of nocturnal hypoglycemia.
- rebound hyperglycemia
- release of counter-regulatory hormones (epinepherine, cortisol, growth hormones)
- S/S's: headache, nightmares, restless sleep, fasting hyperglycemia, normally seen in Pt's with well controlled levels
- Bgl < 60 at 3am
Dawn Phenomenon - increase in counter-regulatory hormones that leads to incr glucose production, a decr in glucose utilization and an incr in morning bgl
- normal bgl at bedtime
- fasting hyperglycemia
- S/S's: normal Bgl at 3am
HYPOGLYCEMIA & HYPERGLYCEMIA
□ Name drug classes that can increase blood sugar levels. - ANSWER-- thiazide diuretics
- sympathomimetics
- glucocorticoids
- antipsychotics
- possibly statins
HYPOGLYCEMIA & HYPERGLYCEMIA
□ What effect does hyperglycemia have on WBCs? - ANSWER-- It inactivates WBCs leading to increased risk of infection.
** Patients with DM are considered to be immune compromised
METFORMIN
□ Which medications target post prandial glucose elevations? - ANSWER-- Metformin
- meglitinides
- alpha-glucosidase inhibitors
- incretin enhancers
METFORMIN
□ Most patients with Type 2 diabetes and normal renal function can be started on___________? - ANSWER-Metformin
METFORMIN
□ Which anti diabetic drug suppresses gluconeogenesis, enhances glucose uptake and utilization by muscle and does not promote insulin secretion or cause hypoglycemia? - ANSWER-Metformin
METFORMIN
□ True or False, Metformin improves insulin resistance? - ANSWER-True
METFORMIN
□ True/False, 10% percentage of patients are intolerant of metformin? - ANSWER-False,
- Actually, about 20% are intolerant
METFORMIN
□ What are the gastrointestinal adverse effects associated with metformin? - ANSWER-Diarrhea
METFORMIN
□ What is the most important rare side effect associated with the use of metformin? - ANSWER-Metformin inhibits lactic acid oxidation leading to lactic acidosis
METFORMIN
□ What conditions may make a person on metformin more prone to lactic acidosis? - ANSWER-- Renal insufficiency
- liver disease
- severe infection
- hypoxemia
METFORMIN
□ What are the clinical signs of lactic acidosis? - ANSWER-- Hyperventilation
- myalgia
- malaise
- unusual somnolence
METFORMIN
□ Why is it necessary to hold metformin prior to diagnostic tests using dyes and prior to surgery? - ANSWER-To decrease the risk of lactic acidosis
METFORMIN
□ Why is metformin contraindicated in patients with renal impairment? - ANSWER-The risk of lactic acidosis is increased when the serum creatinine is elevated
METFORMIN
□ Metformin should be discontinued when the serum creatinine is greater than_________? - ANSWER-Previously recommendations based on Creat:
--> 1.3 in men
--> 1.4 in woman
Recent recommendations based on GFR:
--> lowering the dose to 1000 mg if eGFR is 45
--> discontinuing metformin with a eGFR of 30
- As you know the creatinine is not a good measure of renal function in older adults.
METFORMIN
□ Why should metformin be discontinued in patients with CHF? - ANSWER-Low flow states can increase the risk of lactic acidosis
METFORMIN
□ Which vitamin may be lowered in patients on metformin? - ANSWER-Vitamin B12
METFORMIN
□ Why is it important to recommend B12 supplementation in patients taking metformin? - ANSWER-B12 levels are often found to be lowered in patients taking metformin
METFORMIN
□ Why is it important to check a CBC is patients taking metformin? - ANSWER-Megaloblastic anemia (elevated MCV) is a possible result if B12 levels are diminished
METFORMIN
□ What is the expected HbA1c reduction with the use of metformin? - ANSWER-1-2%
METFORMIN
□ How should metformin be initiated? - ANSWER-Slowly, 500 mg/day with gentle titration to avoid gastrointestinal adverse effects.
- The 500 mg tablets are more tolerable and easier to swallow.
METFORMIN
□ What is the best time of day to take metformin? - ANSWER-Evening meal
- If on 2,000 mg, take 2 tabs every 12 hours with food.
- The extended release can be taken all at once with dinner or split BID
METFORMIN
□ What is the advantage of using extended release metformin? - ANSWER-The entire dose can be taken with the evening meal with less gastrointestinal adverse effects
METFORMIN
□ What is the maximum dose of metformin? - ANSWER-2,000 mg/day.
- Drug sources will list the maximum dose at 2500 mg/day however, there is no additional benefit at doses more than 200 mg/day and increased risk of adverse effects.
METFORMIN
□ Which drugs for DM are on the $4 list at retailers such as Target and Wal-Mart? - ANSWER-Sulfonylureas and metformin
METFORMIN
□ Is metformin free at Publix? - ANSWER-Yes
METFORMIN
□ Does metformin typically cause hypoglycemia? - ANSWER-Not typically
METFORMIN
□ Is metformin considered "disease altering?" - ANSWER-Yes
□ What is the problem with metformin and alcohol? - ANSWER-Alcohol can inhibit the breakdown of lactic acid and contribute to lactic acidosis
□ Can metformin cause weight loss? - ANSWER-Yes, because of the GI effects
□ Why are the 500 mg tablets of metformin preferred over the 1,000 mg tabs? - ANSWER-The larger tablets are very hard to swallow (as if made for a horse...)
SULFONYLUREAS
□ What are the major adverse effects from the oral hypoglycemics for Type 2 diabetics called sulfonylureas? - ANSWER-Hypoglycemia, GI upset, fetal harm, Wt gain, sun sensitivity, incr cardiovascular mortality, hepato-renal insult
SULFONYLUREAS
□ What is the mechanism of action of sulfonylureas? - ANSWER-- They stimulate release of insulin from the pancreas
- "incr indogenous insulin" secretion
- incr tissue response to insulin
examples:
- glipizide (Glucotrol)
- glyburide (Diabeta)
- glimeparide (Amaryl)
** only helpful if beta cell function is present**
SULFONYLUREAS
□ A patient has a known severe allergy to sulfa. Can a sulfonylurea be used? - ANSWER-No, sulfonylureas are not recommended.
- This was more of a problem with the earlier sulfonylureas.
SULFONYLUREAS
□ Which oral hypoglycemic can be used
during pregnancy? - ANSWER-None are approved at the moment and all cross
the placental barrier. [Show Less]