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Diabetes Drugs in the Hospital

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Insulin is the preferred drug for controlling blood glucose levels in the hospital. If you currently take diabetes drugs other than insulin, you are likely to be told to discontinue them during your hospital stay. Continued use of some drugs in the hospital could raise your risk of developing additional health problems. In most cases, however, the use of the drug in the hospital has simply not been studied for safety or effectiveness, so taking it is not advised.

Glimepiride, glipizide, and glyburide. Because these drugs stimulate the pancreas to release more insulin and continue lowering blood glucose for up to 24 hours after they are taken, their use in the hospital could raise the risk of hypoglycemia (low blood glucose) if a person is not eating or is eating less than usual.

Nateglinide (Starlix) and repaglinide (Prandin). These drugs also stimulate the pancreas to release more insulin, but they probably raise the risk of hypoglycemia less than glimepiride, glipizide, and glyburide because their effects are shorter-lived. However, because they are generally taken before meals, and because a person’s food intake may be different from normal while in the hospital, they are likely to be discontinued during a hospital stay.

Metformin. This drug decreases the amount of glucose produced and released by the liver. While it does not cause low blood glucose when used alone, it can have a rare but serious side effect called lactic acidosis, in which the body cells produce lactic acid, leading to acidification of the blood. The risk for lactic acidosis is raised if a person is experiencing kidney problems, respiratory problems, cardiac problems such as congestive heart failure, or liver problems. For this reason, metformin is generally stopped when a person is hospitalized or needs to undergo a procedure or diagnostic test that requires fasting or the injection of an iodinated dye.

Pioglitazone (Actos) and rosiglitazone (Avandia). These drugs decrease insulin resistance by making muscle and fat cells more sensitive to insulin. They also help reduce the amount of glucose released by the liver. However, one of their side effects is to increase the volume of plasma in the blood. (Plasma is the liquid portion of blood.) This can increase the workload of the heart, which can be problematic for people who have or are at risk of developing congestive heart failure or vascular problems (such as atherosclerosis) that limit blood flow to the heart. Your medical team will evaluate the risks and benefits of continuing these drugs when deciding how to manage your blood glucose during a hospital stay.

Sitagliptin (Januvia). While there are no specific safety concerns related to using sitagliptin in the hospital, its use in this setting has not been studied. It is known, however, that doses of this drug need to be decreased in people whose kidneys are not working normally. Also, since the drug primarily lowers after-meal blood glucose levels, it would not be useful for patients who are not eating or are eating much less than usual.

Exenatide (Byetta). This injectable drug signals the pancreas to release insulin when blood glucose levels are high; suppresses the release of glucagon, a hormone that signals the liver to release glucose; and slows the rate at which food moves through the stomach. Since it is mainly used to reduce blood glucose levels after meals, it would not be helpful for people who are not eating or are eating much less than usual.

Pramlintide (Symlin). This injectable drug suppresses the release of glucagon, slows the rate at which food leaves the stomach, and tends to decrease appetite. Since it is mainly used to reduce blood glucose levels after meals, it would not be helpful for people who are not eating or are eating much less than usual.

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