Article Figures & Data
Tables
- Box 1.
Summary guidance on adapting diabetes medication for low carbohydrate management of type 2 diabetes
Drug group Hypo risk? Clinical suggestion Sulphonylureas (for example, gliclazide) and meglitinides (for example, repaglinide) Yes Reduce/stop (if gradual carbohydrate reduction then wean by halving dose successively) Insulins Yes Reduce/stop. Typically wean by 30–50% successively. Beware insulin insufficiencya SGLT2 inhibitors (flozins) No Ketoacidosis risk if insulin insufficiency. Usually stop in community setting Biguanides (metformin) No Optional, consider clinical pros/cons GLP-1 agonists (-enatide/-glutide) No Optional, consider clinical pros/cons Thiazolidinediones (glitazones) No Usually stop, concerns over long-term risks usually outweigh benefit DPP-4 inhibitors (glipitins) No Usually stop, due to lack of benefit Alpha-glucosidase inhibitors (acarbose) No Usually stop, due to no benefit if low starch/sucrose ingestion Self-monitoring blood glucose N/A Ensure adequate testing supplies for patients on drugs that risk hypoglycaemia. Testing can also support behaviour change (for example, paired pre- and post-meal testing) ↵a Caution should be taken when reducing insulin if there is clinical suspicion of endogenous insulin insufficiency (Patients with LADA misdiagnosed as T2D; a minority of T2 patients have endogenous insulin deficiency). Consider these possibilities if patient was not overweight at diagnosis. Exogenous insulin should not be completely stopped in these cases. Inappropriate over-reduction of exogenous insulin will lead to marked hyperglycaemia. Hypo = hypoglycaemia. LADA = latent autoimmune diabetes in adults. T2D = type 2 diabetes.