11
Table 3. Blood Pressure Medication Adjustment
Blood pressure, mm Hg Change in one medication
Systolic Diastolic
<110 NA Decrease by 25–50%
110–149 <95 No change
150–169 95–110 Increase by 25–50%
Notes:
• For patients with controlled blood pressure and/or controlled edema, consider stopping
low-dose or reducing high-dose diuretic medication during first 2–4 weeks to minimize risk
for dehydration. Return to prior dose if BP elevates above goal and/or edema recurs.
• Treat symptomatic hypotension (extreme fatigue) or orthostatic hypotension (dizzy or
lightheaded when going from lying/sitting to standing ) similar to SBP <110 mm Hg.
• If reducing medication already at minimum dose, stop that medication.
• If increasing medication already at maximum dose, add one medication at starting dose.
• Follow diabetes/coronary artery disease/congestive heart failure guidelines regarding choice
of agents when starting or stopping medication.
Figure 2. Initial Diabetes Medication Changes
Hemoglobin A1c
Blood glucose
• Decrease insulin 50%
• Stop secretagogues
• Continue other medications
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.
• Avoid alpha-glucosidase inhibitors (due to diminished efficacy with low-carbohydrate
intake) and SGLT-2 inhibitors (to minimize risk of ketoacidosis).
• Consider adding GLP-1 agonist as insulin is reduced or stopped, as this medication slows
gastric emptying and can facilitate improved glucose control and appetite control.
<10%
<14 mmol/L
≥10%
≥14 mmol/L
• Decrease insulin 25-50%
• Stop secretagogues
• Continue other medications
