05-25-2007, 01:32 PM
This a 60 yo gentleman with CHF amd chronic pancreatitis who has been recently diagnosed with DM2.
Most likely reason for DM: damage of Islet cells secondary to pancreatitis.
(people chronic pancreatitis induced DM - alpha and beta cells destruction are more prone to hypoglycemia)
What Rx for this patient : Insulin
Why:
Metformin is a biguanide contraindicated in CHF, RENAL FAILURE AND ALCOHOLICS.
Pioglitazone is an insulin sensitizer used in Rx of DM2. Contraindicated in patients with CHF NYHA class 3 and 4 as they cause Na and water retention.
Glyburide (sulfonurea) is a insulin secratogogue which is unlikely to work in this case
Most likely reason for DM: damage of Islet cells secondary to pancreatitis.
(people chronic pancreatitis induced DM - alpha and beta cells destruction are more prone to hypoglycemia)
What Rx for this patient : Insulin
Why:
Metformin is a biguanide contraindicated in CHF, RENAL FAILURE AND ALCOHOLICS.
Pioglitazone is an insulin sensitizer used in Rx of DM2. Contraindicated in patients with CHF NYHA class 3 and 4 as they cause Na and water retention.
Glyburide (sulfonurea) is a insulin secratogogue which is unlikely to work in this case