Pharmacology. Pediatric diabetic Case 3

SG is an eleven-year-old African-American male who presents today for a follow-up visit to check his weight and blood glucose. Three months ago, SG was seen in the clinic for fatigue, increased thirst, and frequent urination. SG’s weight was 57 kg (>95%) and his height was 137 cm (25%). SG’s CBC was unremarkable but his blood glucose was 210 mg/dL (he had eaten lunch approximately 2 hours before his appointment). The following day his fasting blood glucose was 170 mg/dL and his Hgb A1C was 8%. At that time, SG was started on a diet and exercise regimen. Today SG weighs 53 kg (95%) and his fasting blood glucose is 140 mg/dL. His Hgb A1C is 7.5%. He tires easily so he has not exercised as much as he should but his diet has improved. It is decided to start SG on metformin to better control his blood glucose concentrations.

1What should be the initial dose of metformin for SG?

2What is metformin’s primary MOA?

3What is the most common adverse effect with the initiation of therapy?

4If SG’s diabetes is not adequately controlled what FDA approved agent should be added to his therapy?

5How does insulin’s effect on A1C compare to other agents used for Type 2 diabetes?

6What is the most significant risk associated with insulin use?

Required textbook.
Brunton, L.B. (Ed). (2011). Goodman & Gilman’s The Pharmacological Basis of Therapeutics (12th edition). McGraw Hills Access Medicine (electronic copy at HSL).