12
Medication Management
Figure 3. Follow-Up Diabetes Medication Changes
Blood glucose range
• Do not take bolus
insulin at time of
measurement
• Decrease insulin
50%
• Stop
secretagogues
Notes:
• When reducing insulin, typically reduce bolus and basal insulins at same time with a
goal to have basal insulin as ½ to ⅔ of total daily dose.
• If no insulin or secretagogue in regimen and blood glucose <14 mmol/L, taper off
thiazolidinedione (due to weight gain side effect) and try to lose weight.
• If adding an agent, choose agents that are weight neutral or lead to weight loss:
metformin, GLP-1 agonists.
• Avoid alpha-glucosidase inhibitors (due to diminished efficacy with low-
carbohydrate intake) and SGLT-2 inhibitors (to minimize risk of ketoacidosis).
<5.6 mmol/L
5.6-8
mmol/L
8-14 mmol/L
14-16.5
mmol/L
≥16.5
mmol/L
• Decrease insulin 50%
• Stop secretagogues
• If weight stable: no
changes.
• If losing weight:
decrease insulin
25-50%
• Stop secretagogues
• If weight stable: add agent
• If losing weight: decrease
insulin 10-25%
• Stop secretagogues
• If weight stable:
add agent
• If losing weight:
no changes or
add agent
