Mini Cases
Patient was recently prescribed glyburide 5 mg PO every morning in additional to their metformin 1000 mg PO BID. Patient take their morning medications at 8 am when they wake up. The patient's first meal is not until 11 am most days. What is the concern for this patient?
Hypoglycemia due to glyburide stimulating secretion of insulin from beta-cells of the pancreas regardless if food is present or not
AB is at the pharmacy to pick up his DM medications. All of a sudden, the patient starts sweating, his face goes white, and he starts fumbling with the credit card machine. You check his glucose and it is 62 mg/dL. What recommendation would you provide to address his hypoglycemia this very moment?
15 g of glucose
4 glucose tablets
4 oz orange juice
3-5 peppermint candies
½ can regular soda
Patient comes to the ER, complaining of persistent severe abdominal pain that radiates to the back and vomiting. Medications include metformin, Victoza, and Invokana. What medication is likely the cause of the patient's pancreatitis?
Victoza (liragluitide) - pancreatitis
SM is a 62 YO F who present to the clinic for management of diabetes. Last month, SM was diagnosed with HFrEF (NYHA Class III). The physician is trying to decide between glipizide or pioglitazone to add to the patient's metformin for glycemic control. Which medication do you recommend?
Glipizide because pioglitazone is contraindicated to initiate in patients with NYHA Class III/IV heart failure
AG is a 45 YO M present to the clinic today for annual physical.
Labs: A1c 10.2%, FBG 180 mg/dL
Meds: metformin 1000 mg PO BID and Ozempic 2 mg SubQ weekly.
What new medication would you recommend to address AG’s A1c?
Basal insulin
(Lantus/Basaglar/Toujeo/Levemir/Tresiba)
(glargine, detemir, degludec)
Patient presents to the ER with nausea/vomiting, lethargy. Relevant labs include glucose: 240 mg/dL, (+) urine ketones. Medications include lisinopril, Farixga, metformin, and Mounjaro. ER team diagnosis is DKA. What medication is responsible?
Farixga (euglycemic DKA)