Kamalakar Pasupuleti said:"Langerhans" <[email hidden]> wrote in message
news:[email hidden]
Quoted message said:I think every doc has his own preferences, but for a T2, most start with
metformin at 500mg qd, ramping it up as the GI distress decreases. Some
seem to add a sulf, either through ignorance or to knock down the
glucotoxicity right away. From there it is all tweaking the meds,
perhaps adding a TZD, until fasting and A1c come down.
Do you mean metformin 500mg twice daily ?
No, I mean 500mg per day as a start, titrating up to a level that works.
The "theraputic" dosage is generally thought to be 1.5g/day. Some need
that much, some less, and some more.
Quoted message said:
Quoted message said:The preferred BP meds for a diabetic are the ACE class, then the ARBs if
people get the bradykinin cough. CCBs have some negative effects in
diabetics, as do BBs.
What are the negative effects ?
Kam
There is lots of controversy afoot regarding the HTN meds and DM due to
potentially conflicting reports from ALLHAT, NHANES-II, and some others.
It was once thought that a diuretic like HCTZ increased BG, as measured
by A1c. It was thought that CCBs also raised BG, *probably* by the
calcium-channel effects on the pancreas or by increasing insulin
resistance in T2s. BBs are still thought of as having the potential to
mask or even potentiate the effects of diabetic autonomic neuropathy.
The studies above have lead to the recommendation that the choice of HTN
med be made based upon other conditions which the patient presents with.
"Diuretics, beta-blockers, CCBs, ACE inhibitors, and ARBs have all been
shown to reduce adverse clinical events in diabetic hypertensives.
Choice of drug for any patient should be individualized. There is
evidence that certain drugs are more useful in preventing damage to a
specific organ system, and so selection of therapy can be based on what
clinical disease the patient is particularly prone to. However, no drug
has been shown to be better than the others in preventing damage to all
the organ systems at risk in the diabetic hypertensive. Beta-blockers
and CCBs are effective antianginals; diuretics, ACE inhibitors, and
beta-blockers are useful for heart failure; CCBs and diuretics are
especially effective in preventing stroke; and ACE inhibitors and ARBs
are especially effective in preserving renal function. Despite its
adverse metabolic profile, diuretics prevent cardiovascular disease as
well as the other, newer antihypertensive agents, and there should be no
hesitation in initiating the diabetic hypertensive on diuretic therapy.
Nevertheless, physicians must remember the need to monitor electrolyte,
glucose, and uric acid levels as well as the renal status of patients on
diuretic therapy."
The above quote was taken from http://www.medscape.com/viewprogram/3989
