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Suggest An Alternate Medicine For Pioglitazone Taken For Hypertension
Question: Hypertension, DM type 2 with chronic renal disease. Renal function recently getting worse with Creatinene increase from 1.45 to 1.67, EFGR decreased from 47 to 34. Hypertension is well controlled. Taking
Pioglitazone 45 mg q day po is not controlling DM 2. I am on law salt diet and walking one hour a day. I'm thinking to change Pioglitazone to another anti-diabetic medication, which would be good for both my diabetes and my stage 3 chronic renal disease. Which medication can you advise me to take. I'm now 85 year old and is a primary care physician.
Pioglitazone 45 mg q day po is not controlling DM 2. I am on law salt diet and walking one hour a day. I'm thinking to change Pioglitazone to another anti-diabetic medication, which would be good for both my diabetes and my stage 3 chronic renal disease. Which medication can you advise me to take. I'm now 85 year old and is a primary care physician.
Brief Answer:
Short acting sulfonylureas are best choice. Glipizide or repaglinide
Detailed Answer:
Thank you for asking
I read your question and i understand your concern. I am sorry for your deteriorating health but as a physician you know that Chronic Kidney disease with worsening eGFR with passage of time with type 2 diabetes is inevitable. Thiazolidinediones are really not a wise option here. With such situation, we recommend short acting sulfonylureas like gliclazide , glipizide or repaglinide. The other better option is of insulin as after 10 to 13 years of type 2 DM average time, insulin exhaustion occurs and one has to switch to insulin . You need to keep n eye on HbA1c and glucose levels to decide if these oral agents are working or you need to shift to insulin.
Of Course nonpharmacological measures like dietary modification, exercise, and weight reduction along with the additional burden of CKD dietary requirements (for example salt, protein, and volume restrictions) is necessary too and itself poses a challenge to glycemic control.
I hope it helps. Take good care of yourself and dont forget to close the discussion please.
Regards
Khan
Short acting sulfonylureas are best choice. Glipizide or repaglinide
Detailed Answer:
Thank you for asking
I read your question and i understand your concern. I am sorry for your deteriorating health but as a physician you know that Chronic Kidney disease with worsening eGFR with passage of time with type 2 diabetes is inevitable. Thiazolidinediones are really not a wise option here. With such situation, we recommend short acting sulfonylureas like gliclazide , glipizide or repaglinide. The other better option is of insulin as after 10 to 13 years of type 2 DM average time, insulin exhaustion occurs and one has to switch to insulin . You need to keep n eye on HbA1c and glucose levels to decide if these oral agents are working or you need to shift to insulin.
Of Course nonpharmacological measures like dietary modification, exercise, and weight reduction along with the additional burden of CKD dietary requirements (for example salt, protein, and volume restrictions) is necessary too and itself poses a challenge to glycemic control.
I hope it helps. Take good care of yourself and dont forget to close the discussion please.
Regards
Khan
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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