Deprescribing and Prescribing Examples:
Deprescribe sliding scale insulin, pre mixed and/or bolus insulin when possible
- Prescribe an agent that has a glucose dependent mechanism (see Safe Prescribing Examples)
- Prescribe a once daily basal insulin regimen if needed (calculate the average mealtime requirements and reduce by 10%-20%)
Deprescribe human insulin (insulin NPH)
- Taper off insulin and prescribe an agent that has a glucose dependent mechanism (see Safe Prescribing Examples) if possible
- Prescribe analogue insulin (insulin glargine) for basal coverage if insulin is required (1:1 conversion or reduce by 10%-20%)
Deprescribe sulfonylureas (i.e., reduce glipizide by 5 mg/day each week until off)
- Prescribe an agent that has a glucose dependent mechanism if additional sugar lowering is needed (see Safe Prescribing Examples)
Monitor for medication contraindications or dose adjustments (see Step 4)
Safe Prescribing Examples:
- Metformin
- DPP-4i
- SGLT2i
- GLP-1 RA
- Thiazolidinediones