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May be used as 3rd line agent in type 2 diabetes, but may cause weight gain and hypoglycaemia
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Need to self monitor glucose levels
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Do not reduce cardiovascular or renal disease independent of glycaemic control
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All patients need to be educated on how to recognise and manage hypoglycaemia, sick day management and diabetes and driving
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NB: Although now 3rd or 4th line agent, sulfonylureas may be used as 1st line agent in steroid-induced hyperglycaemia and many patients were on sulfonylureas prior to the availability of DPPIV inhibitors (e.g. vildagliptin), SGLT2 inhibitors (e.g. empagliflozin) and GLP1 receptor agonists (e.g. dulaglutide). Consider switching patients from sulfonylureas to the newer agents if appropriate as this will reduce the risk of hypoglycaemia and treatment-induced weight gain including abolishing this risk if not on insulin therapy
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Increase insulin secretion by pancreatic β-cells
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Titration of sulfonylureas
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Can double dose of sulfonylureas every 1 -2 weeks until maximum of glipizide 10 mg bd or gliclazide160 mg bd
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Titration is more safely done with monitoring of glucose levels before and 2 hours after meals to ensure no postprandial hypoglycaemia
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Maximum glipizide (10 mg bd) or gliclazide (160 mg bd)
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Glipizide is best sulfonylurea to use if renal impairment
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Doses of sulfonylureas often need to be reduced with declining renal function
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Often need to temporarily stop or reduce dose of sulfonylurea with reduced oral intake
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Should not be used in:
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Children (< 18 years), pregnancy and breastfeeding
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End stage renal or liver failure
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Previous episodes of severe hypoglycaemia
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Significant hypoglycaemic unawareness
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Elderly and/or with cognitive impairment
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Chronic renal and/or liver impairment
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Malnutrition including reduced oral intake and significant alcohol use