Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-40

Caution • Risk of prolonged hypoglycemia: Enhances late insulin secretion, causing delayed hyperinsulinemia. More likely to cause severe hypoglycemia (especially in the elderly). Rate of mild hypoglycemia is 2–4%, and severe hypoglycemia requiring hospitalization is 0.2– 0.4 cases per 1,000 patient-treatment years. • Linked to an increased risk of death or ischemic events; greatest risk associated with higher doses. Cause: Sulfonylureas can close cardiac potassium channels. • Requires lower dose and slower titration in people with renal/hepatic impairment. Contraindicated • Not recommended if eGFR <60 mL/min/1.73m 2 . Considerations in the elderly • Should not be used as associated with the highest risk of severe and fatal hypoglycemia. American Diabetes Association : contraindicated in the elderly

Glyburide (Diabeta®) **O ther sulfonylureas preferred • TDD: 2.5 mg - 20 mg • Frequency: QD/BID if >10mg • Taken 30 min prior to meals. Dosing schedule • Initiate 5.0 mg QD. • Elderly: Initiate 2.5 mg QD • Titrate dose by 2.5 mg every 1–2 weeks. Benefits • Associated with greater suppression of hepatic glucose production and lower FBG levels due to its long half-life (99). • Available: 2.5 mg, 5 mg

UKPDS = United Kingdom Prospective Diabetes Study