Treatment Options to Control Blood Glucose

Treatment Option B: Oral Antidiabetes Medication

2. Insulin sensistizer: metformin (eg, Glucophage)

Metformin is indicated as mono- and combination therapy and as an adjunct to diet and exercise in patients whose serum creatinine levels are less than 1.4 mg/dL (women) or 1.5 mg/dL (men).⁴ Its onset of action is up to 7 days. A potential benefit of metformin may be weight loss, and physicians should consider the use of this drug for obese patients with modest hyperglycemia. As Mrs. S has experienced unexplained weight loss, this potential benefit may help to avoid regaining weight as her blood sugars come under control. Mrs. S also requires more immediate control of hyperglycemia with more potent means.

This patient’s creatinine was 1.1 mg/dL at initial exam, which suggests possible minor renal dysfunction. In most cases, the starting dose of metformin should be low (500 mg qd or 500 mg bid) and titrated slowly to a maximum of 1000 bid, to avoid significant gastrointestinal side effects. Metformin in her regimen would certainly be a consideration.

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