indidoc1
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A 55-year-old woman with a long history of diabetes mellitus type 2 returns to the clinic for a follow-up appointment. She was recently started on a new diabetes regimen after her last hemoglobin A1C was found to be over 10%. Today she is complaining of shortness of breath, worse when she lies down, as well as swelling in her legs. Her diabetes has been poorly controlled over the years, due partly to the severity of her disease and partly to her poor medical compliance. In addition to her diabetes, she is followed in clinic for poorly compensated congestive heart failure, hypertension, and reflux disease. Examination reveals a third heart sound, wet-sounding crackles in both lung bases, and 3+ pitting edema bilaterally. Which of the following diabetes medications was most likely added to her regimen that is responsible for these findings?
A. Acarbose
B. Glyburide
C. Insulin glargine
D. Metformin
E. Rosiglitazone
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| tamerbashir
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E
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| indidoc1
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The correct answer is E. The thiazolidinediones, such as rosiglitazone and pioglitazone, are contraindicated in decompensated heart failure. These medications can cause fluid retention, a dilutional anemia, and precipitate frank anemia. Patients need to be monitored closely for any evidence of heart failure. In addition to edema and heart failure, these medications can be hepatotoxic, requiring regular monitoring of liver function tests.
Acarbose (choice A) is an alpha-glucosidase inhibitor with minimal systemic effects. Its main side effects are gastrointestinal discomfort, flatulence, and diarrhea.
Glyburide (choice B) is a sulfonylurea, and is generally well tolerated. However, because it works by increasing insulin secretion, it has a similar side-effect profile. Weight gain and hypoglycemia are common adverse events.
Insulin (choice C) is unlikely to cause heart failure. The most common effects of insulin are weight gain and hypoglycemia.
Metformin (choice D) can cause a severe metabolic acidosis and should be avoided in patients such as this one, who are predisposed to acidemia because of unstable heart failure.
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| drduck
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good question........yes ........E
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| chemamr
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E 
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