Final Jeopardy
1000

A 64-year-old female was admitted with pneumonia. PMH: T2DM, CKD (eGFR 25), HFpEF. Home meds: metformin, glyburide, pioglitazone, empagliflozin. Admission A1C 9.4%, BG 325 mg/dL. NPO for surgery.

Which meds should be held inpatient, which should continue, and what regimen is safest?

  • Stop: Metformin (eGFR <30), glyburide (hypoglycemia risk), pioglitazone (HF risk), empagliflozin (DKA risk, NPO).

  • Start: Basal insulin (reduce 20–25%).

  • Inpatient regimen: Basal + correction insulin; q4–6h BG checks.

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