Yes
If no contraindictions start therapy with gliclazide
Gliclazide 80mgbd
Monitor fasting capillary glucose (FCG) 3X weekly.
Uptitrate weekly if FCG > 10.0 mmol/L > 2 out of 3 occasions. If FCG remains above 10mmol on maximum Glicazide patient needs to convert to insulin.
Uptitrate fortnightly if FCG in range 6.0-9.9 mmol/L > 2 out of 3 occasions.
Stop up titration if target achieved. If reach maximum Glicazide FCG <9.9 add metformin.
500mg bd. Uptitrate weekly to 850mg bd
At all stages review concordance with all measures for glycaemic control.
Dosing schedule weekly titration:
- Gliclazide 80mg bd
- Gliclazide 160mg am, 80mg pm
- Gliclazide 160mg am, 160mg pm
Metformin intolerance?
- If there is intolerance to metformin at any dose then go back to the previous dose Retry increased metformin dose in a fortnight.
- If tolerated then proceed with up titration.
- If increased dose not tolerated but tolerated dose > 500mg bd then keep on tolerated dose .
On Maximum tolerated metformin/metformin 850mg bd and gliclazide 160mg bd but FPG > 7.0 mmol/L > 2 out of 3 occasions per week .
