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Treatment of Diabetes in Older Patients

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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.

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