Diabetes Mellitus (AACE)

DIabetes Mellitus Comprehensive Care

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Adverse Effects Contraindications Comments Dyspepsia, loose stools, or diarrhea. Can be associated with the development of vitamin B12 deficiency over time. Small increased risk of lactic acidosis. Acute illness, GI or hepatic disease, renal dysfunction, CHF, hypoxic states or alcohol abuse, Cr > 1.4 mg/dL (women) or > 1.5 (men). Withhold in IV contrast dye procedure. The addition of an SU to metformin is associated with a greater than 5-fold increase in likelihood of hypoglycemia over that seen with metformin alone or when an SU is administered in conjunction with TZDs, a DPP-4 inhibitor, or nateglinide. Few adverse events; very low risk of hypoglycemia. Reduce dosage in severe renal insuffiency. Few adverse events. Well tolerated. Possible GI side effects. Low risk of hypoglycemia. Minimal drug-drug interactions. Subcutaneous injection. Significant risk of hypoglycemia; often associated with weight gain. The average weight gain with SU is comparable to that with TZDs. SUs contraindicated in severe liver/ renal disease. Timing is more important for glinides. 17

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