What adjustments should be made for patients with diabetes

What adjustments should be made for patients with diabetes?

The breakdown of insulin decreases as kidney function deteriorates. Patients with diabetes must be monitored for symptoms of hypoglycemia because their insulin requirement may decrease concurrently.

Sulfonylureas that are excreted primarily by the kidneys can accumulate and result in a prolonged hypoglycemic effect. For example, glyburide is metabolized to active metabolites with hypoglycemic properties. A substitute to a drug with greater hepatic excretion, such as glipizide, should be considered when GFR is reduced to less than 50 mL/min. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are a new class of hypogluycemic agents that work by inhibiting glucose absorption from the kidney.

The use of these agents should be avoided in patients with estimated glomerular filtration rate (eGFR) less than 40 mL/min. In addition, AKI has been reported with the use of SGLT2 inhibitors, most likely related to hypoxic injury from osmotic diuresis and dehydration or concomitant use of NSAIDs. Finally, metformin should be used with caution in patients with CKD.

Medication Adjustments for Patients With Diabetes


NORMAL KIDNEY FUNCTION
CHRONIC KIDNEY DISEASE STAGES 3–5HEMODIALYSIS
Metformin500–2000 mg/dayAvoidAvoid (lactic acidosis)
Rosiglitazone4–8 mg/dayCautionCaution (heart failure and fluid retention)
Pioglitazone15–30 mg/dayCautionCaution (heart failure and fluid retention)
Glyburide2.5–10 mg bid50%Avoid
Glipizide5–20 mg bid100%50%
Glimepiride1–8 mg/day50%Avoid
Nateglinide120–180 tid100%100%
Dapagliflozine5-10 mg/dayAvoidFungal urinary tract infections, dehydration and AKI
Canaglifozine100-300 mg/dayAvoidFungal urinary tract infections, dehydration and AKI
Rapaglinide0.5–4 mg tid100%100%
Sitagliptin100 mg/day50 mg/day25 mg/day
15585

Sign up to receive the trending updates and tons of Health Tips

Join SeekhealthZ and never miss the latest health information

15856