It may be necessary to increase the initial dosing from 500 mg BID to 850 mg BID based on glycemic control. This increase will be based on blood glucose control and tolerability of previous dose. Considering that this patients’ blood glucose was at 255, I would anticipate a decrease. The amount of decrease would depend greatly on the combined efforts of dietary modifications, exercise, and other lifestyle changes such as alcohol avoidance. Dose adjustments are variable and patient dependent. It would be crucial to wait and see how this patient tolerates this medication and change in lifestyle.
