Non-Insulin Dosing

Question 1

What is the initial dosing of metformin?

Answer 1

500mg po BID or 850mg po daily

Question 2

How should metformin be titrated?

Answer 2

Weekly or bi-monthly

*increase by 250-500 mg/day

Question 3

What is the maximum dose of metformin?

Answer 3

2 g/day (2000mg)

Question 4

How is metformin dosing determined?

Answer 4

Based on renal function

Question 5

When GFR is > or = 60 how should metformin be dosed?

Answer 5

*This is regular renal function

-No renal contraindication

-Monitor SCr annually

Question 6

When GFR is <60 but > or = 45 how should metformin be dosed?

Answer 6

-Safe to start therapy
-Continue if already using

-Monitor SCr every 3-6 months (2 to 4 times per year)

Question 7

When GFR < 45 and > or = 30, how should metformin be dosed?

Answer 7

-Starting metformin IS NOT RECOMMENDED
-Reduce dose by 50% if already on

-Monitor SCr every 3 months (4 times yearly)

Question 8

When GFR <30 how should metformin be dosed?

Answer 8

-DO NOT START
-STOP if already on

Question 9

How should SGLT2 Inhibitors be dosed around surgery?

Answer 9

-Hold 3 days before surgery
-If ertugliflozin, hold 4 days before

-Restart therapy when oral intake is back to baseline and other ketoacidosis risk factors are resolved

Question 10

When should the GLP-1 Rybelsus be taken?

Answer 10

30 minutes before first food, beverage, or other medications with no more than 4oz water

Question 11

What is the conversion if a patient is on 0.5mg of Ozempic per week and wants to switch to oral Rybelsus?

Answer 11

Change to 7mg po daily of Rybelsus