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• Sheets created by Julienne Kirk, PharmD

• Notes by Dr. Usoh and Kang

• Last updated February 17, 2021

Diabetic foot wounds - Guidelines

• Metformin: can dose in different ways, e.g. 500mg BID or 1000mg once daily are both ok

• No reason to not use Metformin ER. ER has less GI side effects and also on Walmart $4 list

• Start with Metformin, if not at goal <7% by 3 months or higher for older patients, then add second agent

• Sulfonylureas: avoid unless patient could not afford others

• Glipizide: shortest acting, least amount of hypoglycemia potential.

• GLP1 and SGLT2 good choice for second agent

• Do not use DPP4 with GLP1. They do the same thing

• Amylin agonist: injection. Acts more like postprandial agents, can use in conjunction with basal insulin to cover prandial

• Start insulin around A1C 9%

• T1DM: start with 0.2 u/kg

• T2DM: start with 0.5 u/kg if obese or 0.6-1 u/kg if severely obese

• Lantus: start with BID glucose check

• 2-3 week initial follow up

• Add meal time insulin when A1C persistently > 10 or if patient continues to be on high carb meals

• Start with biggest meal in the day first, then add insulin to second biggest meal

• If A1C improves, can start taper insulin. Once Lantus at <15u, can stop and switch back to oral agents

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