Source: Kristen Ng and Sonia Jarrett, EHHOP CC Didactic, 2014
Basic Intervention Algorithm
Try diet and exercise x3mos.
First agent: metformin if A1c not at goal at 3mos
Add second agent: glimepiride or insulin.
PO Hypoglycemics On Formulary
Metformin
Reduction in A1c: 1-2
Advantages: Hypoglycemia is rare, Weight loss
Disadvantages: GI issues (diarrhea), Lactic acidosis, Metallic taste
Contraindications: Cr >1.4 (females), Cr >1.5 (males), Excessive EtOH intake
Metformin dosing algorithm
Sulfonylureas: Glimepiride & Glipizide XL
Reduction in A1c: 1-1.5
Advantages: Rapidly effective
Disadvantages: Hypoglycemia, Weight gain, Disulfiram-like effects
Glimepiride dosing
- Initiation: 1-2mg/day
- Maintenance: increase by 1-2mg every 1 to 2 weeks based on glycemic response
- Max dosage: 8mg/day
Glipizide XL dosing
- Initiation: 5mg/day
- Maintenance: 5 to 10 mg/day
- Max dosage: 20mg/day
Other Diabetes Medications
The following agents are not on formulary at EHHOP as they are expensive, but you may find this reference useful for new patients with a regimen from an outside provider.
