10
Medication Management
Monitoring and Adjusting Medications
• The most important task for the clinician using low-carbohydrate nutrition
therapy is to adjust medications to minimize the risk for hypoglycemia and
hypotension. Note: For safety and efficacy, the authors feel it is important
for the patient to have daily accessibility with the health care team when
adjusting medications so daily adjustments can be made if needed.
• Reducing carbohydrate intake potently reduces blood glucose level, which
means that diabetes medications can be reduced.
▶ Particularly insulin and insulin secretagogues (sulfonylureas, meglitinides) can
lead to hypoglycemia and therefore usually need to be reduced at onset of dietary
change.
• Reducing carbohydrate intake also leads to water loss, partly from the use
of glycogen stores (glycogen is stored with water) and partly from lower
insulin levels (insulin, particularly when combined with hyperglycemia,
signals the kidneys to retain sodium). As a result, blood pressure
can decrease and dehydration can occur if water and sodium are not
replenished.
• Insulin and insulin secretagogues should be adjusted ON THE SAME DAY
that the patient is starting the new eating plan using the algorithms as
guidance.
• Frequency of monitoring thereafter should be individualized based on the
patient's comorbid conditions, concomitant medications, health literacy,
age and other factors.
• For patients taking larger doses of insulin or diuretic, clinic visits every 1-2
weeks may be necessary at the beginning, and avenues for communication
should be made available if advice is needed between visits.
• Elevations of blood glucose in the 150-250 mg/dl range can be tolerated
after medication reductions are made while patients are adapting to
low-carbohydrate nutrition and losing weight—this gives a "buffer" from
hypoglycemic episodes.
• As weight loss continues, blood glucose levels will decline and further
medication reductions may be necessary.
• Visits can be spaced out to monthly when blood glucose or blood pressure
is at goal with no or rare hypoglycemia or hypotension episodes. Visits can
be spaced further, if desired, when weight loss slows to 1-2 lbs. or less per
week.
