Management of Jardiance and Lantus in Patients with Impaired Renal Function

Introduction to Empagliflozin and Insulin Glargine Dosing

The American College of Cardiology recommends reducing insulin dose by approximately 20% when initiating empagliflozin to prevent hypoglycemia 1, 2
The American College of Cardiology suggests considering reducing or stopping sulfonylureas or glinides when initiating empagliflozin 1, 2
If a patient is on diuretics, the American College of Cardiology recommends assessing volume status and considering reducing diuretic dose to prevent intravascular volume contraction 1, 5

The Journal of the American College of Cardiology states that empagliflozin is contraindicated in patients with eGFR <30 mL/min/1.73 m² 1
The Mayo Clinic Proceedings suggest considering switching to GLP-1 receptor agonist (liraglutide, semaglutide, or dulaglutide) when eGFR declines to 30-44 mL/min/1.73 m² 3, 4

The Kidney International recommends starting conservatively and titrating slowly in patients with eGFR <45 mL/min/1.73 m² 2
The Journal of the American College of Cardiology suggests reducing total daily insulin dose by 20-25% when initiating empagliflozin (if eGFR permits) 1, 2

The Kidney International recommends educating patients on hypoglycemia symptoms and treatment 4
The Praxis Medical Insights suggests ensuring patients have access to rapid-acting carbohydrates 4
The Kidney International recommends adjusting doses based on individualized glycemic targets, which may be less stringent in patients with advanced CKD 4

The Kidney International recommends measuring eGFR and urine albumin-to-creatinine ratio (UACR) to assess renal function 4
The Mayo Clinic Proceedings suggest confirming persistence of abnormalities over at least 3 months before diagnosing CKD 4
The Kidney International recommends adding cardio-renal protective agents, such as SGLT2 inhibitors (if eGFR ≥20 mL/min/1.73 m²) or GLP-1 receptor agonists, to the treatment regimen 3, 4