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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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Also need to self monitor blood glucose levels and 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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Increase insulin secretion by pancreatic β-cells
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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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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 blood glucose levels before and 2 hours after meals to ensure no postprandial hypoglycaemia
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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