Treatment
14
Table 6. Medications Used to Treat Hyperglycemia and
Special Concerns with Use in Older Patients With
CKD and CVD
Medication
Class
Use in Older
Patients
Use in Patients
with CKD
Use in Patients
with CVD
Insulin Can cause
hypoglycemia.
Decreased clearance.
Increased risk of
hypoglycemia. Dosages
may need adjusting.
Consider giving
rapid-acting insulin
postprandially because
of gastroparesis.
May worsen
fluid retention
when used with
thiazolidinediones.
Hypoglycemia to
be avoided because
of potential
arrhythmias and
stroke.
Metformin Can cause GI
intolerance.
Does not cause
hypoglycemia.
May cause
Vitamin B12
deficiency.
Reduce dosage to
1000 mg/d if eGFR
<45.
a
Do not start if
eGFR <45.
a
Stop if eGFR <30.
a
Stop if increased risk
of acute kidney injury
(radiocontrast dye,
hypotension, sepsis,
shock, hypoxia).
May be beneficial
in patients with
coronary artery
disease (CAD).
Avoid use in
patients with
severe CHF
to avoid lactic
acidosis.
Sulfonylureas Can cause
hypoglycemia.
Can cause weight
gain.
Avoid glyburide.
Glyburide: avoid if
eGFR <60
a
Glimepiride: avoid if
eGFR <30
a
Glipizide: use with
caution if eGFR <30
a
Can cause
hypoglycemia,
which is to be
avoided because
of potential
arrhythmias and
stroke.
Glinides Can cause
hypoglycemia.
May be useful for
individuals who
skip meals.
Nateglinide: stop if
eGFR <60
a
but can use
if patient on dialysis.
Repaglinide: use with
caution if eGFR <30
a
Can cause
hypoglycemia,
which is to be
avoided because
of potential
arrhythmias and
stroke.
