In making some of these decisions about medication changes, there isn’t always a perfect answer, and people disagree, but I didn’t write this post to tell you that people disagree – hopefully most of you have figured that out by now! Anyway, here’s a brief overview of a recent scenario. A nursing home resident was started on Invokana (you’ll have to go back a few nights if you’re not too familiar with this med), who was also on a moderate dose of Lantus already – about 30-40 units daily if I recall right. The provider did feel that blood sugars were improved per a progress note a few months after initiation of Invokana. Now the A1C results maybe told a different story. They went from 8.2 to 8.1 three months later. So…would this justify the argument to continue a drug that’s in the ballpark of 300/mo? For me, I’d prefer to increase the Lantus (with no recent low blood sugars or signs of hypoglycermia) versus continuing with the Invokana. Obviously there a few more variables in the equation that I can’t recall, but I think this case demonstrates that there is more than “one way to skin a cat” as my gruff former high school science teacher would say!