Glyburide Tablets USP are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Elderly patients are prone to develop renal insufficiency, which may put them at risk of hypoglycemia. Dose selection should include assessment of renal function. Octreotide is to be used only by the patient for whom it is prescribed. Do not share it with other people. benemid
If you miss a dose of Alka-Seltzer effervescent tablets and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. He recommends starting with 200 micrograms of chromium three times per day, and then reducing the dose to twice per day if blood sugar levels improve. Alka-Seltzer effervescent tablets may reduce the number of clot-forming cells platelets in your blood. Avoid activities that may cause bruising or injury. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.
Across all Glyburide and Metformin hydrochloride trials, GI symptoms were the most common adverse events with Glyburide and Metformin hydrochloride and were more frequent at higher dose levels. Find the cause of low blood sugar hypoglycemia. Q11. Are there other risk factors for lactic acidosis? Despite controversy regarding the interpretation of these results, the findings of the UGDP study provide an adequate basis for this warning. The patient should be informed of the potential risks and advantages of Diaβeta and of alternative modes of therapy. Prolonged severe hypoglycemia 4 to 10 days has been reported in neonates born to mothers who were receiving a sulfonylurea drug at the time of delivery. This has been reported more frequently with the use of agents with prolonged half-lives. If glyburide is used during pregnancy, it should be discontinued at least two weeks before the expected delivery date.
Some MEDICINES MAY INTERACT with octreotide. Glucovance, like all blood sugar-lowering medications, can cause side effects in some patients. Most of these side effects are minor. However, there are also serious, but rare, side effects related to Glucovance see Q9-Q13. Bioavailability studies have demonstrated that micronized Glyburide Tablets 3 mg provide serum glyburide concentrations that are not bioequivalent to those from nonmicronized Glyburide Tablets 5 mg. Therefore, patients should be retitrated when transferred from micronized Glyburide Tablets or other oral hypoglycemic agents. Glucovance do not necessarily indicate impending lactic acidosis and may be explainable by other mechanisms, such as poorly controlled diabetes or obesity, vigorous physical activity, or technical problems in sample handling.
What are the symptoms of lactic acidosis? The normal values listed here-called a reference range-are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what's normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab. Dispense in light-resistant containers. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. Do NOT take more than the recommended dose without checking with your doctor. GLUCOVANCE discontinued if evidence of renal impairment is present. The mechanism of action for this interaction is not known. C-peptide test must be done at the same time as a blood glucose test. Hepatic reactions have been reported with sulfonylureas; however, these have not been reported with Diaβeta. Disulfiram-like reactions have been reported very rarely with Diaβeta. Intravenous single-dose studies in normal subjects demonstrate that metformin is excreted unchanged in the urine and does not undergo hepatic metabolism no metabolites have been identified in humans nor biliary excretion. High blood sugar can be lowered by diet and exercise, a number of oral medications, and insulin injections. Before taking Glucovance you should first try to control your diabetes by exercise and weight loss. Even if you are taking Glucovance, you should still exercise and follow the diet recommended for your diabetes. It is unknown if this medication passes into breast milk. However, similar drugs pass into breast milk. Consult your doctor before breast-feeding.
Concomitant medications that may affect renal function or result in significant hemodynamic change or may interfere with the disposition of metformin, such as cationic drugs that are eliminated by renal tubular secretion see PRECAUTIONS, Drug Interactions should be used with caution. Use octreotide with caution in the ELDERLY; they may be more sensitive to its effects. For a listing of dosage forms and brand names by country availability, see Dosage Forms sections. Q7. Can Glyburide and Metformin hydrochloride tablets cause side effects? Diaβeta is excreted as metabolites in the and urine, approximately 50% by each route. This dual excretory pathway is qualitatively different from that of other sulfonylureas, which are excreted primarily in the urine. An increased risk of liver enzyme elevations was observed in patients receiving glyburide concomitantly with bosentan. Therefore concomitant administration of Glynase PresTab and bosentan is contraindicated. Dia” and “ß” on one side and plain on the other side. Whether this interaction also occurs with the intravenous, topical, or vaginal preparations of miconazole is not known. In addition, Glucovance should be promptly withheld in the presence of any condition associated with hypoxemia, dehydration, or sepsis. Because impaired hepatic function may significantly limit the ability to clear lactate, Glucovance should generally be avoided in patients with clinical or laboratory evidence of hepatic disease. Patients should be cautioned against excessive alcohol intake, either acute or chronic, when taking Glucovance, since alcohol potentiates the effects of metformin hydrochloride on lactate metabolism. Patients should be retitrated when transferred from MICRONASE or other oral hypoglycemic agents. BMS" debossed on one side and " 6073" debossed on the opposite side. Do not miss any doses. In a separate study reported in the same paper, 3 women who had delivered via cesarean section and were receiving glyburide 5 mg daily in the immediate postoperative period had milk glyburide levels measured. In order to avoid hypoglycemia, the starting dose of glyburide and metformin hydrochloride tablets should not exceed the daily doses of glyburide or metformin already being taken. Unit dose blister packages of 100 10 cards of 10 tablets each. emsam
Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your heart beat faster; make your vision change; give you a headache, chills, or tremors; or make you more hungry. It is a good idea to carry a reliable source of glucose eg, tablets or gel to treat low blood sugar. If this is not available, you should eat or drink a quick source of sugar like table sugar, honey, candy, orange juice, or non-diet soda. This will raise your blood sugar level quickly. Tell your doctor right away if this happens. To prevent low blood sugar, eat meals at the same time each day and do not skip meals. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Obtain an eGFR at least annually in all patients taking Glyburide and Metformin hydrochloride. Metformin hydrochloride is an antihyperglycemic agent that improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Metformin hydrochloride decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. It may increase the risk of death from heart disease. Talk with your doctor about the benefits and risks of this or other therapies to treat your condition. For severe hypoglycemia, a medical emergency, such as hypoglycemic coma, seizure, or other neurological impairment infrequent transport patient to hospital immediately. If hypoglycemic coma is suspected, give patient a rapid intravenous IV injection of concentrated 50% glucose solution and follow with a continuous IV of 10% glucose solution. Use an infusion rate that will maintain blood glucose level at greater than 100 mg per dL. Monitor patient closely for a minimum of 24 to 48 hours since hypoglycemia may recur after apparent clinical recovery. Hypoglycemia has not been seen with metformin even at doses as high as 85 grams. The administration of oral hypoglycemic drugs has been reported to be associated with increased cardiovascular mortality as compared to treatment with diet alone or diet plus insulin. This warning is based on the study conducted by the University Group Diabetes Program UGDP a long-term prospective clinical trial designed to evaluate the effectiveness of glucose-lowering drugs in preventing or delaying vascular complications in patients with non-insulin-dependent diabetes. The study involved 823 patients who were randomly assigned to one of four treatment groups Diabetes 19 Suppl. Do not remove the medicine from the package until you are ready to take it. Make sure that your hands are dry when you open Alka-Seltzer effervescent tablets. Your risk of developing lactic acidosis from taking Glucovance is very low as long as your kidneys and liver are healthy. However, some factors can increase your risk because they can affect kidney and liver function. You should discuss your risk with your doctor. It is not known whether glyburide or metformin passes into human breast milk. canada eprex over the counter eprex
No exact dosage relationship exists between Glynase PresTab and the other oral hypoglycemic agents, including MICRONASE or Diabeta. Although patients may be transferred from the maximum dose of other sulfonylureas, the maximum starting dose of 3 mg of Glynase PresTab Tablets should be observed. A maintenance dose of 3 mg of Glynase PresTab Tablets provides approximately the same degree of blood glucose control as 250 to 375 mg chlorpropamide, 250 to 375 mg tolazamide, 5 mg of glyburide nonmicronized tablets 500 to 750 mg acetohexamide, or 1000 to 1500 mg tolbutamide. GLUCOVANCE with meals can help reduce these side effects. Talk to your pharmacist if you have questions about this information. If you have any questions about Alka-Seltzer effervescent tablets, please talk with your doctor, pharmacist, or other health care provider. Store octreotide in the refrigerator, between 36 and 46 degrees F 2 and 8 degrees C. Do not freeze. Octreotide may also be stored at room temperature, between 70 and 86 degrees F 20 and 30 degrees C for up to 14 days if protected from light. Throw away multiple-dose vials within 14 days after opening. Open single-dose vials just before use and throw away any unused portion. Store away from heat, moisture, and light. Do not store in the bathroom. Keep octreotide, as well as syringes and needles, out of the reach of children and away from pets. People who have a condition known as glucose-6-phosphate dehydrogenase G6PD deficiency and who take Glucovance may develop hemolytic anemia fast breakdown of red blood cells. G6PD deficiency usually runs in families. Tell your doctor if you or any members of your family have been diagnosed with G6PD deficiency before you start taking Glucovance. Glyburide and metformin hydrochloride tablets should be given with meals and should be initiated at a low dose, with gradual dose escalation as described below, in order to avoid hypoglycemia largely due to glyburide reduce GI side effects largely due to metformin and permit determination of the minimum effective dose for adequate control of blood glucose for the individual patient. Radiologica studies with contrast - Administration of intravascular iodinated contrast agents in metformin-treated patients has led to an acute decrease in renal function and the occurrence of lactic acidosis. Some patients who are initially responsive to oral hypoglycemic drugs, including glyburide, may become unresponsive or poorly responsive over time. Alternatively, glyburide may be effective in some patients who have become unresponsive to one or more other sulfonylurea drugs. how do i clonidine
An increased risk of liver enzyme elevations was observed in patients receiving glyburide concomitantly with bosentan. Therefore concomitant administration of glyburide and metformin and bosentan is contraindicated. WARNING: A small number of people who have taken metformin hydrochloride have developed a serious condition called lactic acidosis. Glyburide and metformin hydrochloride tablets are not recommended for use during pregnancy. The initial and maintenance dosing of glyburide and metformin hydrochloride tablets should be conservative in patients with advanced age, due to the potential for decreased renal function in this population. Any dosage adjustment requires a careful assessment of renal function. Generally, elderly, debilitated, and malnourished patients should not be titrated to the maximum dose of glyburide and metformin hydrochloride tablets to avoid the risk of hypoglycemia. Monitoring of renal function is necessary to aid in prevention of metformin-associated lactic acidosis, particularly in the elderly see WARNINGS. Octreotide may restore fertility in some women with acromegaly who were unable to become pregnant. If you wish to avoid pregnancy, you should use effective birth control while you use octreotide. For these reasons, FAERS case reports cannot be used to calculate incidence or estimates of risk for a particular product or compare risks between products. Persons allergic to other sulfonamide derivatives may develop an allergic reaction to glyburide as well. Octreotide may cause dizziness, drowsiness, or vision changes. These effects may be worse if you take it with alcohol or certain medicines. Use octreotide with caution. There are no adequate and well-controlled studies in pregnant women with Glucovance or its individual components. No animal studies have been conducted with the combined products in Glucovance. The following data are based on findings in studies performed with the individual products. Your doctor has prescribed glyburide and metformin to treat your type 2 diabetes. This is also known as non-insulin-dependent diabetes mellitus. To reduce your risk of side effects such as your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Glucovance. Your liver helps remove lactic acid from your bloodstream. Glyburide Tablets should be added gradually to the dosing regimen of patients who have not responded to the maximum dose of metformin monotherapy after four weeks see and . Refer to metformin package insert. These are thought to be related to fluctuation in glucose levels. awab.info tenormin
The sulfonylurea works by causing the pancreas to release insulin, which helps to lower blood sugar levels. The biguanide works by decreasing the amount of sugar that the liver produces and the intestines absorb. It also helps to make your body more sensitive to the insulin that you naturally produce. With initial treatment and during dose titration, appropriate blood glucose monitoring should be used to determine the therapeutic response to Glyburide and Metformin hydrochloride and to identify the minimum effective dose for the patient. Thereafter, HbA 1c should be measured at intervals of approximately 3 months to assess the effectiveness of therapy. The therapeutic goal in all patients with type 2 diabetes is to decrease FPG, PPG, and HbA 1c to normal or as near normal as possible. Ideally, the response to therapy should be evaluated using HbA 1c glycosylated hemoglobin which is a better indicator of long-term glycemic control than FPG alone. Glyburide and metformin combines two antihyperglycemic agents with complementary mechanisms of action, to improve glycemic control in patients with type 2 diabetes. Metabolic Reactions: Hepatic porphyria and disulfiram-like reactions have been reported with sulfonylureas; however, hepatic porphyria has not been reported with glyburide and disulfiram-like reactions have been reported very rarely. There is no fixed dosage regimen for the management of diabetes mellitus with Glynase PresTab Tablets. In addition to the usual monitoring of urinary glucose, the patient's blood glucose must also be monitored periodically to determine the minimum effective dose for the patient; to detect primary failure, ie, inadequate lowering of blood glucose at the maximum recommended dose of medication; and to detect secondary failure, ie, loss of adequate blood glucose lowering response after an initial period of effectiveness. Glycosylated hemoglobin levels may also be of value in monitoring the patient's response to therapy. Metformin: Steady-state concentration is reached in 24-48 hours. Q8. What are the most common side effects of Glyburide and Metformin hydrochloride tablets? If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In addition to its blood glucose lowering actions, glyburide produces a mild diuresis by enhancement of renal free water clearance. Disulfiram-like reactions have very rarely been reported in patients treated with glyburide. Some Type II diabetic patients being treated with insulin may respond satisfactorily to Glynase PresTab. No studies have been performed specifically examining the safety and efficacy of switching to glyburide and metformin hydrochloride tablets therapy in patients taking concomitant glyburide or other sulfonylurea plus metformin. Changes in glycemic control may occur in such patients, with either hyperglycemia or hypoglycemia possible. Any change in therapy of type 2 diabetes should be undertaken with care and appropriate monitoring. High blood sugar can be lowered by diet and exercise, a number of oral medications, and insulin injections. Before taking glyburide and metformin you should first try to control your diabetes by exercise and weight loss. Even if you are taking glyburide and metformin, you should still exercise and follow the diet recommended for your diabetes. The metformin component of Glucovance is bioequivalent to metformin coadministered with glyburide. I23" debossed on one side and plain on the other side. Glucovance experienced hypoglycemic symptoms. If you notice these symptoms, or if your medical condition has suddenly changed, stop taking Glucovance tablets and call your doctor right away. Lactic acidosis is a medical emergency that must be treated in a hospital. There have been no clinical studies establishing conclusive evidence of risk reduction with Diaβeta or any other anti-diabetic drug. Most people wo have had lactic acidosis with metformin have other things that, combined with the metformin, led to the lactic acidosis. This may not be a complete list of all interactions that may occur. Ask your health care provider if Alka-Seltzer effervescent tablets may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. Due to a lack of dose proportionality, increased doses of metformin may not result in greater bioavailability. Do not share your pen device with another person, even if the needle is changed. You may give other people a serious infection, or get a serious infection from them. Learn how to store and discard medical supplies safely. order now cheap flagyl visa
Patients should be informed of the potential risks and benefits of glyburide and metformin and of alternative modes of therapy. They should also be informed about the importance of adherence to dietary instructions, of a regular exercise program, and of regular testing of blood glucose, glycosylated hemoglobin, renal function, and hematologic parameters. Glyburide appears to lower blood glucose acutely by stimulating the release of insulin from the pancreas, an effect dependent upon functioning beta cells in the pancreatic islets. The mechanism by which glyburide lowers blood glucose during long-term administration has not been clearly established. With chronic administration in patients with type 2 diabetes, the blood glucose lowering effect persists despite a gradual decline in the insulin secretory response to the drug. Extrapancreatic effects may be involved in the mechanism of action of oral sulfonylurea hypoglycemic drugs. Glyburide is not recommended for use in pregnancy or for use in pediatric patients. See Usual adult dose. G6PD deficiency and a non-sulfonylurea alternative should be considered. In postmarketing reports, hemolytic anemia has also been reported in patients who did not have known G6PD deficiency. C-peptide test can also help find the cause of such as excessive use of medicine to treat or a noncancerous growth tumor in the pancreas insulinoma. Because man-made synthetic insulin does not have C-peptide, a person with a level from taking too much insulin will have a low C-peptide level but a high level of insulin. An insulinoma causes the pancreas to release too much insulin, which causes to drop hypoglycemia. A person with an insulinoma will have a high level of C-peptide in the blood when they have a high level of insulin. Close monitoring should continue until the physician is assured that the patient is out of danger. The longer elimination half-life in blood suggests that metformin may distribute into red blood cells. If Alka-Seltzer effervescent tablets has a strong vinegar-like smell upon opening, or if Alka-Seltzer effervescent tablets does not fizz when placed in water, it means the medicine is breaking down. Throw the medicine away safely and out of the reach of children; contact your pharmacist and replace. This information is not specific medical advice and does not replace information you receive from your health care provider. Keep this and all drugs out of the reach of children. Dermatologic: Porphyria cutanea tarda and photosensitivity reactions have been reported with sulfonylureas. Excessive Alcohol intake - Alcohol is known to potentiate the effect of metformin on lactate metabolism. Patients, therefore, should be warned against excessive alcohol intake, acute or chronic, while receiving Glyburide and Metformin hydrochloride. Patients receiving Glyburide and Metformin hydrochloride in combination with a thiazolidinedione may be at risk for hypoglycemia. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip themissed dose and resume your usual dosing schedule. Hypoxic states - Several of the postmarketing cases of metformin-associated lactic acidosis occurred in the setting of acute congestive heart failure particularly when accompanied by hypoperfusion and hypoxemia. Cardiovascular collapse shock acute myocardial infarction, sepsis, and other conditions associated with hypoxemia have been associated with lactic acidosis and may cause prerenal azotemia. When such an event occurs, discontinue Glyburide and Metformin hydrochloride. atrovent buy store usa
Glucovance is not recommended for use during pregnancy. The initial and maintenance dosing of Glucovance should be conservative in patients with advanced age, due to the potential for decreased renal function in this population. Any dosage adjustment requires a careful assessment of renal function. Generally, elderly, debilitated, and malnourished patients should not be titrated to the maximum dose of Glucovance to avoid the risk of hypoglycemia. Monitoring of renal function is necessary to aid in prevention of metformin-associated lactic acidosis, particularly in the elderly. Reevaluate eGFR 48 hours after the imaging procedure, and restart Glyburide and Metformin hydrochloride if renal function is stable. Treatment with Glyburide and Metformin hydrochloride resulted in significantly greater reduction in HbA 1c and postprandial plasma glucose PPG compared to glyburide, metformin, or placebo. Also, Glyburide and Metformin hydrochloride therapy resulted in greater reduction in FPG compared to glyburide, metformin, or placebo, but the differences from Glyburide and Metformin did not reach statistical significance. No animal studies have been done that combine both glyburide and metformin. Animal data is based only on individual products. Differences in safety and efficacy were not determined between these patients and younger patients, but greater sensitivity of some older individuals cannot be ruled out. But there's little evidence that consuming more magnesium helps treat the disease. The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch. The molecular weight is 493. There is no information on the effect of gender on the pharmacokinetics of glyburide. Diaβeta tablets USP contain the active ingredient glyburide and the following inactive ingredients: dibasic calcium phosphate USP, magnesium stearate NF, microcrystalline cellulose NF, sodium alginate NF, talc USP. order stromectol pharmacy
Glyburide and Metformin hydrochloride tablets USP contain 2 oral antihyperglycemic drugs used in the management of type 2 diabetes, glyburide, USP and metformin hydrochloride, USP. Limited data indicate that the levels of glyburide in milk are negligible. Monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with hypoglycemic agents. Multiple-dose studies with glyburide in patients with type 2 diabetes demonstrate drug level concentration-time curves similar to single-dose studies, indicating no buildup of drug in tissue depots. Disulfiram-like reactions have very rarely been reported in patients treated with glyburide tablets. There is very little chance of a problem from having a blood sample taken from a vein. Already concerned about such problems two years ago, the Aptos, Calif. No studies have been performed specifically examining the safety and efficacy of switching to Glucovance therapy in patients taking concomitant glyburide or other sulfonylurea plus metformin. Changes in glycemic control may occur in such patients, with either hyperglycemia or hypoglycemia possible. Any change in therapy of type 2 diabetes should be undertaken with care and appropriate monitoring. Glyburide and metformin combination should be taken with food to reduce gastrointestinal symptoms. After 16 weeks, there was no significant change in the mean HbA 1c in patients randomized to glyburide or metformin therapy. You may get a small at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes. Follow the diet and exercise program given to you by your health care provider. clomipramine
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Possible interactions between glyburide and coumarin derivatives have been reported that may either potentiate or weaken the effects of coumarin derivatives. The mechanism of these interactions is not known. Are there any serious side effects that glyburide and metformin can cause? Short-term administration of Glyburide Tablets may be sufficient during periods of transient loss of control in patients usually controlled well on diet. Hepatic impairment - Patients with hepatic impairment have developed cases of metformin-associated lactic acidosis. This may be due to impaired lactate clearance resulting in higher lactate blood levels. Therefore, avoid use of Glyburide and Metformin hydrochloride in patients with clinical or laboratory evidence of hepatic disease. can i order diltiazem-ointment online
University of Toronto researcher Vladamir Vulksan, PhD, announced at the American Diabetes Association ADA annual meeting in June 2000 that he'd gotten some positive results using ginseng. Q8. What are the most common side effects of GLUCOVANCE? Therefore, hemodialysis may be useful for removal of accumulated drug from patients in whom metformin overdosage is suspected. Little is known about how other herbs might help control diabetes. and bilberry have been studied in animal experiments, but have yet to undergo large, controlled human studies. The reputation of two other herbs, gymnome and jambul, rests on anecdotal evidence alone.
Sulfonylurea drugs are extensively bound to serum proteins. Displacement from protein binding sites by other drugs may lead to enhanced hypoglycemic action. In vitro, the protein binding exhibited by glyburide is predominantly non-ionic, whereas that of other sulfonylureas chlorpropamide, tolbutamide, tolazamide is predominantly ionic. Acidic drugs such as phenylbutazone, warfarin, and salicylates displace the ionic-binding sulfonylureas from serum proteins to a far greater extent than the non-ionic binding glyburide. It has not been shown that this difference in protein binding will result in fewer drug-drug interactions with glyburide in clinical use.
The safety and efficacy of Glucovance were evaluated in an active-controlled, double-blind, 26-week randomized trial involving a total of 167 pediatric patients ranging from 9-16 years of age with type 2 diabetes. Glucovance was not shown statistically to be superior to either metformin or glyburide with respect to reducing HbA 1c from baseline see Table 5. No unexpected safety findings were associated with Glucovance in this trial. GLUCOVANCE. See printed below. Some Type II diabetic patients being treated with insulin may respond satisfactorily to Glyburide Tablets. Although it is not known whether glyburide is excreted in human milk, some sulfonylurea drugs are known to be excreted in human milk. Because the potential for hypoglycemia in nursing infants may exist, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. If the drug is discontinued, and if diet alone is inadequate for controlling blood glucose, insulin therapy should be considered.