Table 4.
Comparison of insulin and noninsulin hypoglycemic agents in the hospital
| Noninsulin Agents | Insulina | |
|---|---|---|
| Frequency of titration | Days to weeks | Daily |
|
| ||
| Adaptability to changes in nutritional status | + | +++ |
|
| ||
| Duration of hypoglycemia | None (M, T, G) | Hours |
| Days (S) | ||
|
| ||
| Other cautions | Renal dysfunction (M, S) | Rare |
| Liver disease (M, S, T) | ||
| Lactic acidosisb (M) | ||
| Nausea/vomiting/pancreatitis (G) | ||
| Heart failure (T, M) | ||
| Elderly (M, S) | ||
DPP-4 inhibitors are generally safe but have limited efficacy and there are limited data for use in the hospital.
Abbreviations: G, GLP-1 (exenatide, liraglutide, pramlintide); M, metformin; S, sulfonylureas; T, thiazolidinediones.
a
Using a physiologic regimen.
b
Metformin-associated lactic acidosis is increased in patients with renal dysfunction (and IV contrast administration), acidosis, respiratory failure, acute heart failure, and hemodynamic compromise.