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Oral agents for diabetes ques

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mdphd2b

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This was a real ques from my Fam Med exam. How would you answer this question?

Which of the following diabetic oral agents has the LEAST risk of causing hypoglycemia?

A. sulfonylurea
B. metformin
C. insulin
D. rosiglitazone

I chose A, but not sure if I reasoned correctly. Any takers?
 

QuinnB

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I think sulfonylureas would be the second most common behind insulin.

The order would go: Insulin > Sulfonylureas > Rosiglitazone > Metformin

I haven't verified this but I remember that metformin has the dreaded "lactic acidosis" as the "well known" side effect. In endocrine clinic, I have seen the first three precipitate hypoglycemic episodes.
 

velo

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its metformin, sulfonylureas mechanism of action causes insulin release so they would be ~2nd most likely to cause hypoglycemia behind insulin as the previous poster mentioned.
 

werd

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def. metformin. it doesn't cause wt. gain either.
 

Dr JPH

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Metformin has no action on insulin. You cant become hypoglycemic from metformin alone, altough combination therapy may allow for this.

What metformin can do in relation to hypoglycemia is actually mask some of the symptoms of hypoglycemia. Some patients report that while on metformin they do not notice any feelings of hunger during hypoglycemic episodes. This seems to be anectodal and not yet well studied, but it is possible.

TZDs also do not generally cause hypoglycemia when used in single therapy.

SO I would put insulin in ANY form nearer the top along with sulfonyureas.

Metformin, TZDs, metglitinides near the bottom
 

mdphd2b

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OP here...

Thanks for the input. Let's see if I get it...I agree insulin is definitely the worst, and it sounds like any drug that would increase insulin secretion would similarly be a problem, so sulfonylurea is out. So that leaves either metformin or a TZD (rosiglitazone). Of these 2, metformin is the least likely candidate to cause hypoglycemia?
 

Dr JPH

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Of these 2, metformin is the least likely candidate to cause hypoglycemia?

Methinks that would be the case. You can try looking around for articles concerning metformin and TZDs with rates of hypoglycemia.

Either way, let us know. I want to see if I would have gotten the correct answer as well! I need all the moral support I can get. :)
 

NJEMT1

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According to Blueprints Medicine, Metformin is the one least likely to cause hypoglycemia.
 

vwhan

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Let me add to this thread, metformin
 
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