P1: RLJ/OZN P2: KUF
0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41
478 Diabetes Mellitus, Type 2■Side Effects & Contraindications
■Metformin:
➣Side effects: abdominal pain, diarrhea, lactic acidosis
➣Contraindications: pregnancy, breast feeding, renal insufficiency
(Cr=1.5 mg/dL), uncompensated CHF, severe hepatic dysfunc-
tion, marked alcoholism
■Sulfonylureas:
➣Side effects: hypoglycemia, GI, allergy
➣Contraindications: pregnancy, breast feeding
■Glitazones (thiazolidinediones):
➣Side effects: hepatitis, edema
➣Contraindications: pregnancy, breast feeding, liver disease,
severe CHF
■Alpha-glucosidase inhibitors:
➣Side effects: abdominal pain, diarrhea, flatulence
➣Contraindications: pregnancy, breast feeding, cirrhosis, IBD,
intestinal obstruction
■Insulin:
➣Side effects: hypoglycemia, lipohypertrophy, lipoatrophy, insulin
allergy, insulin antibodies
➣Contraindications: nonefollow-up
■See well-controlled, stable patients q 6 mo
■See poorly controlled patients or those well-controlled on insulin q
3 mo or more frequently, PRN
■Review records of home glucose monitoring (HGM), adherence,
symptoms of hyper- or hypoglycemia, chronic complications, other
illnesses, medications, lifestyle changes, psychosocial issues
■Weight, BP, and foot exam at each visit
■HgbA1cquarterly orq6mo
■Serum lipid profile yearly or more frequently if abnormal
■Dilated eye exam, serum creatinine, urine microalbumin yearlycomplications and prognosis
■Retinopathy: develops in 50–90%, best treated by near-normal glu-
cose control, BP management, and photocoagulation therapy by
ophthalmologist; may lead to blindness in up to 10%
■Neuropathy: develops in 50–90%, best treated by near-normal glu-
cose control; predisposes to foot ulcers and amputations