Nateglinide (nateglinide)
Hypoglycemics - Sulfonylureas and Related Non-Sulfonylureas Oral Tablet
Last reviewed · Source: First Databank (FDB) drug data
Overview
Nateglinide, a meglitinide derivative (glinide), is a short-acting, insulinotropic antidiabetic agent.
Nateglinide, a d-phenylalanine derivative, is an insulinotropic antidiabetic agent. Like repaglinide, nateglinide is a meglitinide-derivative (glinide) antidiabetic agent that is structurally unrelated to oral sulfonylurea antidiabetic agents and repaglinide. Functioning pancreatic beta-cells are required for nateglinide's hypoglycemic activity since the drug lowers blood glucose concentrations principally by augmenting endogenous insulin secretion from the pancreas in response to a meal.
The extent of insulin release is glucose dependent and diminishes at low blood glucose levels. Nateglinide interacts with the ATP-sensitive potassium channel on pancreatic beta-cells; nateglinide is highly tissue selective with low affinity for heart and skeletal muscle.
Following oral administration of nateglinide immediately prior to a meal, peak plasma concentration occurs within 1 hour; the absolute bioavailability is 73%. Nateglinide stimulates pancreatic insulin secretion within 20 minutes of oral administration. The pharmacokinetics of nateglinide are not affected by the composition of a meal (e.g., high protein, fat, or carbohydrate); when given with or after meals, AUC is unaffected but there is a delay in the rate of absorption characterized by a decrease in peak plasma concentrations and a delay in time to peak plasma concentration.
Peak plasma levels are significantly reduced when nateglinide is administered 10 minutes prior to a liquid meal as compared to a solid meal. Nateglinide is extensively (98%) bound to plasma proteins, primarily serum albumin and to alpha1-acid glycoprotein to a lesser extent. Nateglinide is extensively metabolized by cytochrome P-450 (CYP) 2C9 and, to a lesser extent, CYP3A4 isoenzymes.
The major metabolites are less potent antidiabetic agents than the parent drug with the exception of the isoprene minor metabolite, which possesses potency similar to that of the parent compound. Based on nateglinide's ability to inhibit the metabolism of tolbutamide in vitro, the drug may be an inhibitor of CYP2C9 in vivo. The average elimination half-life of nateglinide is 1.5 hours.
Nateglinide and its metabolites are rapidly and completely eliminated following oral administration; 83% of radiolabeled nateglinide was recovered in the urine (16% as parent drug) and 10% was eliminated in the feces. No pharmacokinetic data are available in patients with mild (creatinine clearance 60--89 mL/minute) renal impairment. Patients with moderate and severe (creatinine clearance 15--50 mL/minute) renal impairment not on dialysis display similar apparent clearance, AUC, and peak plasma concentrations.
Patients with renal failure requiring dialysis exhibit reduced overall drug exposure and reduced plasma protein binding. In patients with mild hepatic impairment, an increase in peak plasma concentration and AUC of 37% and 30%, respectively, were observed compared to healthy matched control subjects. There are no data on the pharmacokinetics of nateglinide in patients with moderate-to-severe hepatic impairment.
Age, race, and sex do not influence the pharmacokinetics of nateglinide.
USES: Nateglinide is used alone or with other medications to control high blood sugar along with a proper diet and exercise program. It is used in people with type 2 diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems.
Proper control of diabetes may also lessen your risk of a heart attack or stroke. It works by stimulating the body to produce more insulin. Insulin is a natural substance that allows the body to properly use sugar from the diet.
Generic name: nateglinide
Pronunciation: (nah-TEGG-lin-ide)
Drug class: Hypoglycemics - Sulfonylureas and Related Non-Sulfonylureas
Therapeutic class: Endocrine
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Nateglinide
Indications
The following indications are listed for Nateglinide:
- Type 2 Diabetes Mellitus
Also known as: Adult Onset Diabetes, Adult Onset Diabetes Mellitus, Adult Onset Dm, Diabetes Mellitus Type 2, Diabetes Mellitus Type Ii, Ketosis-Resistant Diabetes Mellitus, Ketosis-Resistant Dm, Maturity Onset Diabetes, Maturity Onset Diabetes Mellitus, Non-Insulin Dependent Diabetes Mellitus, Non-Insulin-Dependent Diabetes Mellitus, Type Ii Diabetes Mellitus.
Dosing
No dosing information is available for this tab.
Nateglinide is administered orally 3 times daily 1-30 minutes before meals.
If a meal is skipped, the dose of nateglinide corresponding to that meal should be skipped.
Store nateglinide tablets at 25degreesC in a tight container; excursions permitted to 15--30degreesC.
| Drug label | Dosing type | Instructions |
|---|---|---|
| Nateglinide 120 Mg Tablet | Maintenance | Take 1 tablet (120 mg) by oral route 3 times per day 1 to 30 minutes prior to meals. |
| Drug label | Dosing type | Instructions |
|---|---|---|
| Nateglinide 120 Mg Tablet | Maintenance | Take 1 tablet (120 mg) by oral route 3 times per day 1 to 30 minutes prior to meals. |
Drug interactions
The major metabolic pathway for nateglinide is hydroxylation followed by glucuronide conjugation; metabolism occurs primarily by cytochrome P-450 (CYP) 2C9 (70%) and to a lesser extent by CYP3A4 (30%).
Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
Selected Photosensitizers/Tretinoin-Mequinol
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Tretinoin, anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are all known photosensitizers.(1)
CLINICAL EFFECTS: Concurrent use of tretinoin in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The US manufacturer states that tretinoin-mequinol should not be administered to patients receiving photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides.(1)
DISCUSSION: Because of the risk of increased photosensitivity, the US manufacturer states that tretinoin-mequinol should not be administered to patients receiving photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), methotrexate, phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides.(1)
Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
Antidiabetic Agents/Gatifloxacin
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: The exact mechanism is unknown.
CLINICAL EFFECTS: Concurrent use of gatifloxacin may result in hypoglycemia and/or hyperglycemia.(1-4) Hypoglycemia is more common during the first three days of concurrent therapy. Hyperglycemia is more common after the first three days of concurrent therapy.(2)
PREDISPOSING FACTORS: Elderly patients, especially those with decreased renal function may be predisposed to this interaction.(2)
PATIENT MANAGEMENT: Patients receiving concurrent gatifloxacin should be closely monitored for hypoglycemia during the first three days of concurrent therapy and for hyperglycemia after the first three days of concurrent therapy. Patients should be instructed to discontinue gatifloxacin if hypoglycemia or hyperglycemia occur.(2)
DISCUSSION: Hypoglycemia has been reported with gatifloxacin and glyburide(1,5,6) or glimepiride.(7) In a study in patients with type 2 diabetes mellitus, concurrent gatifloxacin (400 mg daily for 10 days) had no effect on the pharmacokinetics of glyburide (steady state daily regimen); however, pharmacodynamic interactions have been reported.(2) Health Canada has received 19 reports of hypoglycemia in patients taking gatifloxacin. Seventeen of these involved concurrent hypoglycemic agents. Health Canada has received 2 reports of hyperglycemia in patients taking gatifloxacin and hypoglycemic agents. Health Canada has received 2 reports of patients experiencing hypoglycemia and hyperglycemia during concurrent gatifloxacin and hypoglycemic agents.(3) In a study, 13 reports of dysglycemia were reported in patients taking gatifloxacin. Ten of these patients had diabetes mellitus and were on concurrent hypoglycemic agents. Of these ten patients, nine patients experienced hypoglycemia, while one patient experienced hyperglycemia.(8)
Selected Photosensitizers/Aminolevulinic Acid
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Aminolevulinic acid, anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are all known photosensitizers.(1)
CLINICAL EFFECTS: Concurrent use of aminolevulinic acid in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The US manufacturer states that aminolevulinic acid should be avoided in patients receiving photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides for 24 hours before and after administration of aminolevulinic acid.(1)
DISCUSSION: Because of the risk of increased photosensitivity, the US manufacturer states that aminolevulinic acid should be avoided in patients receiving photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides for 24 hours before and after administration of aminolevulinic acid.(1)
Selected Photosensitizers/Methoxsalen
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Methoxsalen causes photosensitivity due to residual drug which is present in all parts of the skin from photopheresis. Anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are other known photosensitizers.(1)
CLINICAL EFFECTS: Concurrent use of methoxsalen in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The US manufacturer of methoxsalen states that concurrent use of methoxsalen with anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides should be avoided.(1)
DISCUSSION: All patients who have received methoxsalen become photosensitive. It is unknown what the risk of photosensitivity reactions is when methoxsalen is used concurrently with other photosensitizing agents.(1)
Selected Photosensitizers/Porfimer
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Porfimer causes photosensitivity due to residual drug which is present in all parts of the skin. Anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are other known photosensitizers.(1)
CLINICAL EFFECTS: Concurrent use of porfimer in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1)
PREDISPOSING FACTORS: Patients with any hepatic impairment and patients with severe renal impairment have reduced drug elimination and may remain photosensitive for 90 days or longer.(1)
PATIENT MANAGEMENT: The US manufacturer of porfimer states that concurrent use of porfimer with photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), methotrexate, St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides should be avoided.(1) Since the photosensitive effect of porfimer may persist for at least 30 days (and for 90 days in some patients), it would be prudent to avoid other photosensitizing agents for at least 30 days after administration of porfimer.
DISCUSSION: All patients who have received porfimer become photosensitive. It is unknown what the risk of photosensitivity reactions is when porfimer is used concurrently with other photosensitizing agents. When porfimer was used in clinical trials, photosensitivity reactions occurred in about 20% of cancer patients and in 69% of high-grade dysplasia in Barretts esophagus patients. Most of the reactions were mild to moderate erythema, but they also included swelling, pruritus, burning sensation, feeling hot, or blisters. The majority of reactions occurred within 90 days of porfimer administration.(1)
Moderate Interaction: Assess the risk to the patient and take action as needed.
Antidiabetic Agents/Gymnema
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Gymnema has been shown to increase the number of insulin-secreting beta cells in animals. It has also been shown to increase the activity of enzymes responsible for glucose uptake and utilization and inhibit peripheral utilization of glucose.(1)
CLINICAL EFFECTS: Use of gymnema may result in decreased requirements of antidiabetic agents.(2-4)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Diabetic patients should be carefully monitored if gymnema is initiated or discontinued from concurrent therapy. The dosage of the patient's antidiabetic agent(s) may need to be adjusted.(2)
DISCUSSION: In a study in 22 non-insulin-dependent patients, patients had decreased blood glucose, glycosylated hemoglobin, and glycosylated plasma proteins during gymnema therapy. Patients were able to decrease the dosage of their conventional antidiabetic therapy and five patients were able to discontinue their conventional antidiabetic therapy.(3) In a study in 27 insulin-dependent patients, patients had decreased insulin requirements, fasting blood glucose, glycosylated hemoglobin, and glycosylated plasma protein levels.(4)
Antidiabetics, Oral/Aspirin (> 100 Mg); Salicylates
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Complex. Salicylates appear to have intrinsic glucose lowering properties via several proposed mechanisms. Also, salicylates may cause protein binding displacement of antidiabetics. Decreased renal clearance may also occur.
CLINICAL EFFECTS: Potentiation of hypoglycemic effects may be observed.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Hypoglycemic signs and blood glucose levels should be monitored. Adjust the antidiabetic dose as needed. Particular caution should be taken when salicylates are started or stopped in patients previously stabilized on antidiabetics.
DISCUSSION: Additional documentation is necessary to confirm this potential interaction.
Antidiabetics, Oral/Oxy-Phenylbutazone
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Phenylbutazone may displace antidiabetics from plasma protein binding sites. Renal elimination of the active metabolite of acetohexamide may be reduced. Finally, tolbutamide metabolism may be decreased.
CLINICAL EFFECTS: Potentiation of antidiabetic effects.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Hypoglycemic signs and blood glucose levels should be monitored. Adjust the antidiabetic dose as needed.
DISCUSSION: This interaction is well documented.
Antidiabetics/Epinephrine
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Gluconeogenesis, glycogenolysis, and lipolysis are increased by epinephrine. Also, insulin secretion and glucose uptake by peripheral tissues are decreased by epinephrine.
CLINICAL EFFECTS: Increased blood glucose resulting in decreased effectiveness of the antidiabetic agent.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Caution when starting or stopping epinephrine in diabetic patients. Adjust the antidiabetic dose as needed based on blood glucose levels.
DISCUSSION: This interaction is likely to occur based upon well documented properties of the interacting drugs. However, there is individual variability in its occurrence.
Antidiabetics/Slt Ophth Non-Cardioselective Beta-Blockers
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Not fully established. Probably blockade of a variety of beta-adrenergic responses to hypoglycemia.(1,2)
CLINICAL EFFECTS: Diminished response to sulfonylureas and insulin may occur. Frequency and severity of hypoglycemic episodes may be increased, while warning symptoms of low blood sugar may be masked.(1,2)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Try to avoid beta-blocker therapy, particularly in diabetics prone to hypoglycemic attacks. One of the cardioselective agents may decrease risk of hypertensive attacks and allow more rapid glucose recovery from hypoglycemia. Patients should be counseled not to rely on tachycardia to diagnose hypoglycemia, since it is masked by beta-blocker therapy. Diaphoresis is unaffected by beta-blockade and can be used by the diabetic to recognize hypoglycemia.
DISCUSSION: A double blind, randomized, 12 month study of 39 patients tested the metabolic effects of pindolol (5mg BID) compared to control group on insulin sensitivity. The patient's insulin sensitivity index decreased 17% when on pindolol treatment compared to placebo (p<0.01). Insulin mediated glucose uptake was significantly lower (p<0.05) with propranolol treatment than with placebo.(3) A study of 26 patients with chronic heart failure showed that carvedilol (average daily dose 27.5mg/d) caused a significant decrease in fasting insulin levels (17.09 to 10.77 microU/ml, p <0.05) compared to pre-treatment levels. This trial also showed that patients on carvedilol had significantly (p=0.015) lower fasting insulin levels (10.77 microU/ml) compared to the fasting insulin levels (20.72 microU/ml) of patients on bisoprolol treatment (5.9mg/d).(4) There have been case reports of hypoglycemia following the addition of ophthalmic timolol to a diabetic regimen.(5-7) Studies have shown that ophthalmic beta-blockers, especially the aqueous solution, have significant systemic absorption and do not undergo first-pass metabolism.(8,9)
Glinides; Sulfonylureas/Ethyl Alcohol
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Alcohol can induce hypoglycemia and interfere with gluconeogenesis in the liver by means of intrinsic hypoglycemic activity.(1-3) Some alcoholic beverages may increase serum glucose levels from their high carbohydrate content.(4) Chronic alcohol intake may decrease half-life of sulfonylureas by increasing liver metabolism.(1, 5-8)
CLINICAL EFFECTS: Alcohol consumption while on a glinide or sulfonylureas may result in a range of reactions, from mild flushing to severe hypoglycemic reactions. Alcohol consumption during chlorpropamide therapy has resulted in a disulfiram-like reaction.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Diabetics should be cautioned about the effects of alcohol consumption on diabetic control, possible flushing with concurrent use, and about unsuspected sources of alcohol such as medications. Patients on chlorpropamide therapy should be counseled about the possibility of a disulfiram-like reaction to alcohol consumption. Alcohol is used to improve docetaxel and paclitaxel solubility. - The quantity of alcohol in paclitaxel injection formulations (0.385-0.396 grams/mL) is similar across manufacturers. A paclitaxel 200 mg dose contains approximately 13 grams of alcohol. - The quantity of alcohol in docetaxel formulations varies approximately 3-fold depending upon the manufacturer. FDA data on alcohol content (21): Product Manufacturer Alcohol/200 mg dose Docetaxel Inj. Pfizer 6.4 grams Docetaxel Inj. Sandoz 5.5 grams Docetaxel Inj. Accord 4.0 grams Taxotere-one vial Sanofi 4.0 grams formulation Docetaxel Inj. Hospira 3.7 grams Docefrez Sun Pharma 2.9 grams Taxotere-two vial Sanofi 2.0 grams formulation
DISCUSSION: Chlorpropamide has been reported to induce facial flushing (5,9-18) and a disulfiram-like reaction(4,9,10,18,19) following alcohol consumption. Tolbutamide has been shown to interact with alcohol in nonalcoholic diabetic patients, alcoholics, and normal subjects.(2,3,6-8,16,17) There is one report of reduced tolerance for alcohol in a patient on tolazamide therapy.(20) In a study in 10 normal subjects, administration of ethanol with glipizide resulted in a delay in return to fasting glucose levels. The time of onset and the extent of hypoglycemia were not altered.(21) Glipizide and glyburide have been reported to have a very low incidence of disulfiram-like reactions with concurrent alcohol; however, in one study, 5 of 11 patients taking glyburide developed flushing after a test dose of alcohol.(18)
Hypoglycemics; Insulin/Bupropion
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Bupropion can lower the seizure threshold and when given concurrently with other medications that also lower the threshold there is an increased risk of seizure. Concurrent use of hypoglycemics or insulin increases the risk of hypoglycemia which can result in seizures.(1,2)
CLINICAL EFFECTS: Concurrent use of bupropion and hypoglycemics or insulin may increase the risk of seizure.(1,2)
PREDISPOSING FACTORS: The risk of seizures may be increased in patients with a history of head trauma or prior seizure; CNS tumor; severe hepatic cirrhosis; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; use of over-the-counter stimulants an anorectics; a total daily dose of bupropion greater than 450 mg or single doses greater than 150 mg; rapid escalation of bupropion dosage; or with concomitant medications known to lower seizure threshold (antidepressants, antipsychotics, systemic steroids, theophylline).(1,2)
PATIENT MANAGEMENT: The use of bupropion in patients treated with oral hypoglycemic agents or insulin should be undertaken only with extreme caution and with low initial bupropion dosing and small gradual dosage increases.(1,2) Single doses should not exceed 150 mg.(1,2) The maximum daily dose of bupropion should not exceed 300 mg for smoking cessation(2) or 450 mg for depression.(1)
DISCUSSION: Because of the risk of seizure from concurrent bupropion and other agents that lower seizure threshold, the manufacturer of bupropion states that the concurrent use of bupropion and oral hypoglycemic agents or insulin should be undertaken only with extreme caution and with low initial bupropion dosing and small gradual dosage increases.(1,2)
Nateglinide; Repaglinide/Slt Non-Cardioselective B-Blockers
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Not fully established. Probably blockade of a variety of beta-adrenergic responses to hypoglycemia. MECHANISM OF ACTION: Not fully established. Probably blockade of a variety of beta-adrenergic responses to hypoglycemia.
CLINICAL EFFECTS: Diminished response to nateglinide and repaglinide may occur. Frequency and severity of hypoglycemic episodes may be increased, while warning symptoms of low blood sugar may be masked. CLINICAL EFFECTS: Diminished response to nateglinide and repaglinide may occur. Frequency and severity of hypoglycemic episodes may be increased, while warning symptoms of low blood sugar may be masked.
PREDISPOSING FACTORS: None determined. PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Try to avoid beta-blocker therapy, particularly in diabetics prone to hypoglycemic attacks. One of the cardioselective agents may decrease risk of hypertensive attacks and allow more rapid glucose recovery from hypoglycemia. Patients should be counseled not to rely on tachycardia to diagnose hypoglycemia, since it is masked by beta-blocker therapy. Diaphoresis is unaffected by beta-blockade and can be used by the diabetic to recognize hypoglycemia. PATIENT MANAGEMENT: Try to avoid beta-blocker therapy, particularly in diabetics prone to hypoglycemic attacks. One of the cardioselective agents may decrease risk of hypertensive attacks and allow more rapid glucose recovery from hypoglycemia. Patients should be counseled not to rely on tachycardia to diagnose hypoglycemia, since it is masked by beta-blocker therapy. Diaphoresis is unaffected by beta-blockade and can be used by the diabetic to recognize hypoglycemia.
DISCUSSION: A class effect of diminished glucose-lowering effects is expected with concurrent use of beta-blockers and nateglinide or repaglinide. It is prudent to monitor serum glucose closely in patients receiving beta-blocker therapy because symptoms of hypoglycemia may be masked. A double blind, randomized, 12 month study of 39 patients tested the metabolic effects of pindolol (5 mg BID) compared to control group on insulin sensitivity. The patient's insulin sensitivity index decreased 17% when on pindolol treatment compared to placebo (p<0.01). Insulin mediated glucose uptake was significantly lower (p<0.05) with propranolol treatment than with placebo. (1) A study of 26 patients with chronic heart failure showed that carvedilol (average daily dose 27.5 mg/d) caused a significant decrease in fasting insulin levels (17.09 to 10.77 microU/ml, p <0.05) compared to pre-treatment levels. This trial also showed that patients on carvedilol had significantly (p=0.015) lower fasting insulin levels (10.77 microU/ml) compared to the fasting insulin levels (20.72 microU/ml) of patients on bisoprolol treatment (5.9mg/d).(2) DISCUSSION: A double blind, randomized, 12 month study of 39 patients tested the metabolic effects of pindolol (5 mg BID) compared to control group on insulin sensitivity. The patient's insulin sensitivity index decreased 17% when on pindolol treatment compared to placebo (p<0.01). Insulin mediated glucose uptake was significantly lower (p<0.05) with propranolol treatment than with placebo. (1) A study of 26 patients with chronic heart failure showed that carvedilol (average daily dose 27.5 mg/d) caused a significant decrease in fasting insulin levels (17.09 to 10.77 microU/ml, p <0.05) compared to pre-treatment levels. This trial also showed that patients on carvedilol had significantly (p=0.015) lower fasting insulin levels (10.77 microU/ml) compared to the fasting insulin levels (20.72 microU/ml) of patients on bisoprolol treatment (5.9mg/d).(2)
Selected Antidiabetic Agents/Chloroquine; Hydroxychloroquine
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: The exact mechanism is unknown. Chloroquine and hydroxychloroquine may increase insulin sensitivity by inhibiting insulin metabolism and inflammation and increasing cellular uptake of glucose and glycogen synthesis.(1,2) These effects may result in additive hypoglycemia with anti-diabetic agents.
CLINICAL EFFECTS: Concurrent use of chloroquine or hydroxychloroquine and antidiabetic agents may result in severe hypoglycemia.(3) Hypoglycemia can lead to coma.
PREDISPOSING FACTORS: Elderly patients, especially those with decreased renal function may be predisposed to this interaction.
PATIENT MANAGEMENT: Patients maintained on antidiabetic agents who require concurrent therapy with chloroquine or hydroxychloroquine should be closely monitored for hypoglycemia. A decrease in the dose of insulin or other anti-diabetic medications may be required. Patients should be advised of the risk and symptoms of hypoglycemia and to contact their doctor if hypoglycemia occurs.(3) Signs of hypoglycemia may include confusion, dizziness, feeling shaky, unusual hunger, headaches, irritability, pounding heart or very fast pulse, pale skin, sweating, trembling, weakness, or unusual anxiety.
DISCUSSION: Hydroxychloroquine has been shown to cause severe hypoglycemia including loss of consciousness that could be life threatening.(3) Concomitant hypoglycemic agents may increase the risk and/or severity of this effect. A 77 year old man who was stable on twice daily insulin suffered two episodes of hypoglycemic coma 2 weeks after starting prednisone 5 mg daily and hydroxychloroquine 400 mg daily for rheumatoid arthritis. His insulin dosage required a decrease of 37%.(4) Many studies have investigated the glucose-lowering effect of hydroxychloroquine. In a clinical trial of type II diabetics on maximal doses of sulfonylureas, addition of hydroxychloroquine lowered hemoglobin A1C (HbA1C) up to 1% more than placebo.(5) Another clinical trial of type II diabetics on metformin and glimepiride or gliclazide found that hydroxychloroquine 400 mg daily reduced fasting blood glucose (FBG), post-prandial glucose (PPG), and HbA1C to a similar degree as pioglitazone 15 mg daily at 24 weeks.(6) In a prospective observational study, 250 uncontrolled type II diabetics on metformin, glimepiride, pioglitazone, sitagliptin, and a SGLT-2 inhibitor received hydroxychloroquine 400 mg daily for 48 weeks. HbA1C decreased from 8.83% to 6.44%, FBG decreased by 40.78%, and PPG decreased by 58.95%. The doses of metformin were reduced by 50%, glimepiride and sitagliptin by 75%, and SGLT-2 inhibitors were discontinued in most patients.(7)
Selected Antidiabetic Agents/Selected Quinolones
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: The exact mechanism is unknown.
CLINICAL EFFECTS: Concurrent use of quinolones and antidiabetic agents may result in severe hypoglycemia.(1-7) Hypoglycemia can lead to coma.
PREDISPOSING FACTORS: Elderly patients, especially those with decreased renal function may be predisposed to this interaction.(5)
PATIENT MANAGEMENT: Patients maintained on antidiabetic agents who require concurrent therapy with a quinolone should be closely monitored for hypoglycemia.(1-4) Patients should be instructed to discontinue quinolone use and contact their doctor if hypoglycemia occurs.(2,4) Signs of hypoglycemia may include confusion, dizziness, feeling shaky, unusual hunger, headaches, irritability, pounding heart or very fast pulse, pale skin, sweating, trembling, weakness, or unusual anxiety.
DISCUSSION: Hypoglycemia has been reported with concurrent ciprofloxacin and glyburide,(1,8,9) levofloxacin and glyburide,(2,10,11) norfloxacin and glyburide,(3) levofloxacin and glipizide (12) as well as levofloxacin and metformin-glibenclamide.(14) There has been one report of fatal hypoglycemia with concurrent levofloxacin and glyburide(9) and one of the above reports of hypoglycemia with concurrent levofloxacin and glyburide resulted in hypoxic brain injury.(11) A review of postmarketing adverse event data for the fluoroquinolones and hypoglycemic coma identified 56 reports in FAERS search from October 1987- April 2017 and 11 additional cases in the medical literature. Most patients had risk factors for hypoglycemia. 41 patients were taking one or more hypoglycemic drugs. 13 deaths occurred (some of these patients had renal insufficiency). 9 patients did not fully recover and had resultant disability.(13)
Selected Antidiabetics/Maois
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: The exact mechanism by which MAO inhibitors affect carbohydrate metabolism and subsequent enhancement of the hypoglycemic action of insulin is not clear. The adrenergic response to hypoglycemia may be blocked by insulin release caused by MAOI's. In vitro studies have shown that MAO inhibitors are capable of both potentiating and inhibiting insulin release, depending on their concentrations. Stimulation of glucose-mediated insulin secretion is believed to be related to the MAO inhibitory effects of the drugs.
CLINICAL EFFECTS: The hypoglycemic response to both insulin and glucose lowering agents including alpha glucosidase inhibitors, meglitinides, and sulfonylurea may be increased.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Concurrent MAO inhibitor therapy for depression in a diabetic patient will often require reduction in dosage of the hypoglycemic agent because of enhanced hypoglycemic effects. Since the extent of the reaction is highly unpredictable, any diabetic patients receiving MAO inhibitors should be monitored for possible excessive hypoglycemia.
DISCUSSION: This interaction is likely to occur. The interaction between MAOIs and insulin is well documented. Additional documentation is necessary to confirm the potential interaction of MAOI's with other glucose lowering agents including alpha glucosidase inhibitors, meglitinides, and sulfonylureas but is expected to occur based on pharmacologic similarity. It may take several weeks for the full hypoglycemic effect of the MAOI to occur. Conversely, it may take several weeks for the effect to dissipate after stopping the MAOI. Furazolidone is known to be a monoamine oxidase inhibitor. Methylene blue, when administered intravenously, has been shown to reach sufficient concentrations to be a potent inhibitor of MAO-A. Metaxalone is a weak inhibitor of MAO.
Selected Antidiabetics/Safinamide
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: The exact mechanism by which MAO inhibitors such as safinamide affect carbohydrate metabolism and subsequent enhancement of the hypoglycemic action of insulin is not clear. The adrenergic response to hypoglycemia may be blocked by insulin release caused by MAOI's. In vitro studies have shown that MAO inhibitors are capable of both potentiating and inhibiting insulin release, depending on their concentrations. Stimulation of glucose-mediated insulin secretion is believed to be related to the MAO inhibitory effects of the drugs.
CLINICAL EFFECTS: The hypoglycemic response to both insulin and glucose lowering agents including alpha glucosidase inhibitors, meglitinides, and sulfonylurea may be increased.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Concurrent MAO inhibitor therapy for depression in a diabetic patient will often require reduction in dosage of the hypoglycemic agent because of enhanced hypoglycemic effects. Since the extent of the reaction is highly unpredictable, any diabetic patients receiving MAO inhibitors should be monitored for possible excessive hypoglycemia.
DISCUSSION: This interaction is likely to occur. The interaction between MAOIs and insulin is well documented. Additional documentation is necessary to confirm the potential interaction of MAOI's with other glucose lowering agents including alpha glucosidase inhibitors, meglitinides, and sulfonylureas but is expected to occur based on pharmacologic similarity. It may take several weeks for the full hypoglycemic effect of the MAOI to occur. Conversely, it may take several weeks for the effect to dissipate after stopping the MAOI.
Contraindications
*Known hypersensitivity to nateglinide or any ingredient in the formulation.
There are no contraindication contraindications for this drug.
- Hypoglycemic disorder
There are no moderate contraindications for this drug.
Adverse reactions
The most common adverse effects of nateglinide (>=3% of patients) are upper respiratory tract infection, back pain, flu symptoms, dizziness, arthropathy, and diarrhea.
Less Frequent
- Hypoglycemic disorder
Rare or Very Rare
- Abnormal hepatic function tests
- Cholestatic hepatitis
- Hypersensitivity drug reaction
- Jaundice
More Frequent
- Upper respiratory infection
- Weight gain
Less Frequent
- Arthritis
- Back pain
- Bronchitis
- Cough
- Diarrhea
- Dizziness
- Flu-like symptoms
Rare or Very Rare
- Pruritus of skin
- Skin rash
- Urticaria
Precautions
No enhanced messaging available.
Safety and efficacy not established in pediatric patients less than 18 years of age.
There is insufficient evidence with nateglinide in pregnant women to evaluate a drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. In animal reproduction studies, there was no teratogenicity in rats and rabbits administered oral nateglinide during organogenesis at approximately 27 and 8 times the maximum recommended human dose, respectively, based on body surface area.
Poorly controlled diabetes in pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, and delivery complications. Poorly controlled diabetes increases the fetal risk for major birth defects, stillbirth, and macrosomia related mortality. Nateglinide should be used during pregnancy only if the benefit justifies the potential risk to the fetus.
There is no information on the presence of nateglinide in human milk, the effects on the breast-fed infant, or the effects on milk production. Nateglinide is distributed into milk in rats. Because of the potential for hypoglycemia in nursing infants, nateglinide is not recommended for use while breastfeeding.
No dosage adjustment is necessary based on age; greater sensitivity of some older individuals to nateglinide cannot be ruled out.
No substantial differences in safety and efficacy nor in the pharmacokinetics relative to younger adults, but increased sensitivity cannot be ruled out.
ICD codes
| Code | Type | Description |
|---|---|---|
| Type 2 diabetes mellitus | ||
| E08 | ICD10CM | Diabetes mellitus due to underlying condition |
| E08.0 | ICD10CM | Diabetes mellitus due to underlying condition with hyperosmolarity |
| E08.00 | ICD10CM | Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHc) |
| E08.01 | ICD10CM | Diabetes mellitus due to underlying condition with hyperosmolarity with coma |
| E08.1 | ICD10CM | Diabetes mellitus due to underlying condition with ketoacidosis |
| E08.10 | ICD10CM | Diabetes mellitus due to underlying condition with ketoacidosis without coma |
| E08.11 | ICD10CM | Diabetes mellitus due to underlying condition with ketoacidosis with coma |
| E08.2 | ICD10CM | Diabetes mellitus due to underlying condition with kidney complications |
| E08.21 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic nephropathy |
| E08.22 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic chronic kidney disease |
| E08.29 | ICD10CM | Diabetes mellitus due to underlying condition with other diabetic kidney complication |
| E08.3 | ICD10CM | Diabetes mellitus due to underlying condition with ophthalmic complications |
| E08.31 | ICD10CM | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy |
| E08.311 | ICD10CM | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema |
| E08.319 | ICD10CM | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema |
| E08.32 | ICD10CM | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy |
| E08.321 | ICD10CM | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema |
| E08.3211 | ICD10CM | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E08.3212 | ICD10CM | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E08.3213 | ICD10CM | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E08.3219 | ICD10CM | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E08.329 | ICD10CM | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema |
| E08.3291 | ICD10CM | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| E08.3292 | ICD10CM | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| E08.3293 | ICD10CM | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| E08.3299 | ICD10CM | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E08.33 | ICD10CM | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy |
| E08.331 | ICD10CM | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema |
| E08.3311 | ICD10CM | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E08.3312 | ICD10CM | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E08.3313 | ICD10CM | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E08.3319 | ICD10CM | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E08.339 | ICD10CM | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema |
| E08.3391 | ICD10CM | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| E08.3392 | ICD10CM | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| E08.3393 | ICD10CM | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| E08.3399 | ICD10CM | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E08.34 | ICD10CM | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy |
| E08.341 | ICD10CM | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema |
| E08.3411 | ICD10CM | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E08.3412 | ICD10CM | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E08.3413 | ICD10CM | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E08.3419 | ICD10CM | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E08.349 | ICD10CM | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema |
| E08.3491 | ICD10CM | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| E08.3492 | ICD10CM | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| E08.3493 | ICD10CM | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| E08.3499 | ICD10CM | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E08.35 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy |
| E08.351 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema |
| E08.3511 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye |
| E08.3512 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye |
| E08.3513 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral |
| E08.3519 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E08.352 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula |
| E08.3521 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E08.3522 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E08.3523 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E08.3529 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E08.353 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula |
| E08.3531 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E08.3532 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E08.3533 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E08.3539 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E08.354 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment |
| E08.3541 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E08.3542 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E08.3543 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E08.3549 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E08.355 | ICD10CM | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy |
| E08.3551 | ICD10CM | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye |
| E08.3552 | ICD10CM | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye |
| E08.3553 | ICD10CM | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral |
| E08.3559 | ICD10CM | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye |
| E08.359 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema |
| E08.3591 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye |
| E08.3592 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye |
| E08.3593 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral |
| E08.3599 | ICD10CM | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E08.36 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic cataract |
| E08.37 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment |
| E08.37x1 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye |
| E08.37x2 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye |
| E08.37x3 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral |
| E08.37x9 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye |
| E08.39 | ICD10CM | Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication |
| E08.4 | ICD10CM | Diabetes mellitus due to underlying condition with neurological complications |
| E08.40 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified |
| E08.41 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic mononeuropathy |
| E08.42 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic polyneuropathy |
| E08.43 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy |
| E08.44 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic amyotrophy |
| E08.49 | ICD10CM | Diabetes mellitus due to underlying condition with other diabetic neurological complication |
| E08.5 | ICD10CM | Diabetes mellitus due to underlying condition with circulatory complications |
| E08.51 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene |
| E08.52 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene |
| E08.59 | ICD10CM | Diabetes mellitus due to underlying condition with other circulatory complications |
| E08.6 | ICD10CM | Diabetes mellitus due to underlying condition with other specified complications |
| E08.61 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic arthropathy |
| E08.610 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy |
| E08.618 | ICD10CM | Diabetes mellitus due to underlying condition with other diabetic arthropathy |
| E08.62 | ICD10CM | Diabetes mellitus due to underlying condition with skin complications |
| E08.620 | ICD10CM | Diabetes mellitus due to underlying condition with diabetic dermatitis |
| E08.621 | ICD10CM | Diabetes mellitus due to underlying condition with foot ulcer |
| E08.622 | ICD10CM | Diabetes mellitus due to underlying condition with other skin ulcer |
| E08.628 | ICD10CM | Diabetes mellitus due to underlying condition with other skin complications |
| E08.63 | ICD10CM | Diabetes mellitus due to underlying condition with oral complications |
| E08.630 | ICD10CM | Diabetes mellitus due to underlying condition with periodontal disease |
| E08.638 | ICD10CM | Diabetes mellitus due to underlying condition with other oral complications |
| E08.64 | ICD10CM | Diabetes mellitus due to underlying condition with hypoglycemia |
| E08.641 | ICD10CM | Diabetes mellitus due to underlying condition with hypoglycemia with coma |
| E08.649 | ICD10CM | Diabetes mellitus due to underlying condition with hypoglycemia without coma |
| E08.65 | ICD10CM | Diabetes mellitus due to underlying condition with hyperglycemia |
| E08.69 | ICD10CM | Diabetes mellitus due to underlying condition with other specified complication |
| E08.8 | ICD10CM | Diabetes mellitus due to underlying condition with unspecified complications |
| E08.9 | ICD10CM | Diabetes mellitus due to underlying condition without complications |
| E09 | ICD10CM | Drug or chemical induced diabetes mellitus |
| E09.0 | ICD10CM | Drug or chemical induced diabetes mellitus with hyperosmolarity |
| E09.00 | ICD10CM | Drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHc) |
| E09.01 | ICD10CM | Drug or chemical induced diabetes mellitus with hyperosmolarity with coma |
| E09.1 | ICD10CM | Drug or chemical induced diabetes mellitus with ketoacidosis |
| E09.10 | ICD10CM | Drug or chemical induced diabetes mellitus with ketoacidosis without coma |
| E09.11 | ICD10CM | Drug or chemical induced diabetes mellitus with ketoacidosis with coma |
| E09.2 | ICD10CM | Drug or chemical induced diabetes mellitus with kidney complications |
| E09.21 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic nephropathy |
| E09.22 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease |
| E09.29 | ICD10CM | Drug or chemical induced diabetes mellitus with other diabetic kidney complication |
| E09.3 | ICD10CM | Drug or chemical induced diabetes mellitus with ophthalmic complications |
| E09.31 | ICD10CM | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy |
| E09.311 | ICD10CM | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E09.319 | ICD10CM | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| E09.32 | ICD10CM | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy |
| E09.321 | ICD10CM | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema |
| E09.3211 | ICD10CM | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E09.3212 | ICD10CM | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E09.3213 | ICD10CM | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E09.3219 | ICD10CM | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E09.329 | ICD10CM | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema |
| E09.3291 | ICD10CM | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| E09.3292 | ICD10CM | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| E09.3293 | ICD10CM | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| E09.3299 | ICD10CM | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E09.33 | ICD10CM | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy |
| E09.331 | ICD10CM | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema |
| E09.3311 | ICD10CM | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E09.3312 | ICD10CM | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E09.3313 | ICD10CM | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E09.3319 | ICD10CM | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E09.339 | ICD10CM | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema |
| E09.3391 | ICD10CM | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| E09.3392 | ICD10CM | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| E09.3393 | ICD10CM | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| E09.3399 | ICD10CM | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E09.34 | ICD10CM | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy |
| E09.341 | ICD10CM | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema |
| E09.3411 | ICD10CM | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E09.3412 | ICD10CM | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E09.3413 | ICD10CM | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E09.3419 | ICD10CM | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E09.349 | ICD10CM | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema |
| E09.3491 | ICD10CM | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| E09.3492 | ICD10CM | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| E09.3493 | ICD10CM | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| E09.3499 | ICD10CM | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E09.35 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy |
| E09.351 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema |
| E09.3511 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| E09.3512 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| E09.3513 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| E09.3519 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E09.352 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula |
| E09.3521 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E09.3522 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E09.3523 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E09.3529 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E09.353 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula |
| E09.3531 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E09.3532 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E09.3533 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E09.3539 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E09.354 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment |
| E09.3541 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E09.3542 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E09.3543 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E09.3549 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E09.355 | ICD10CM | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy |
| E09.3551 | ICD10CM | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
| E09.3552 | ICD10CM | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
| E09.3553 | ICD10CM | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
| E09.3559 | ICD10CM | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
| E09.359 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema |
| E09.3591 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| E09.3592 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| E09.3593 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| E09.3599 | ICD10CM | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E09.36 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic cataract |
| E09.37 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment |
| E09.37x1 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
| E09.37x2 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
| E09.37x3 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
| E09.37x9 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
| E09.39 | ICD10CM | Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication |
| E09.4 | ICD10CM | Drug or chemical induced diabetes mellitus with neurological complications |
| E09.40 | ICD10CM | Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified |
| E09.41 | ICD10CM | Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy |
| E09.42 | ICD10CM | Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy |
| E09.43 | ICD10CM | Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy |
| E09.44 | ICD10CM | Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy |
| E09.49 | ICD10CM | Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication |
| E09.5 | ICD10CM | Drug or chemical induced diabetes mellitus with circulatory complications |
| E09.51 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E09.52 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E09.59 | ICD10CM | Drug or chemical induced diabetes mellitus with other circulatory complications |
| E09.6 | ICD10CM | Drug or chemical induced diabetes mellitus with other specified complications |
| E09.61 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic arthropathy |
| E09.610 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy |
| E09.618 | ICD10CM | Drug or chemical induced diabetes mellitus with other diabetic arthropathy |
| E09.62 | ICD10CM | Drug or chemical induced diabetes mellitus with skin complications |
| E09.620 | ICD10CM | Drug or chemical induced diabetes mellitus with diabetic dermatitis |
| E09.621 | ICD10CM | Drug or chemical induced diabetes mellitus with foot ulcer |
| E09.622 | ICD10CM | Drug or chemical induced diabetes mellitus with other skin ulcer |
| E09.628 | ICD10CM | Drug or chemical induced diabetes mellitus with other skin complications |
| E09.63 | ICD10CM | Drug or chemical induced diabetes mellitus with oral complications |
| E09.630 | ICD10CM | Drug or chemical induced diabetes mellitus with periodontal disease |
| E09.638 | ICD10CM | Drug or chemical induced diabetes mellitus with other oral complications |
| E09.64 | ICD10CM | Drug or chemical induced diabetes mellitus with hypoglycemia |
| E09.641 | ICD10CM | Drug or chemical induced diabetes mellitus with hypoglycemia with coma |
| E09.649 | ICD10CM | Drug or chemical induced diabetes mellitus with hypoglycemia without coma |
| E09.65 | ICD10CM | Drug or chemical induced diabetes mellitus with hyperglycemia |
| E09.69 | ICD10CM | Drug or chemical induced diabetes mellitus with other specified complication |
| E09.8 | ICD10CM | Drug or chemical induced diabetes mellitus with unspecified complications |
| E09.9 | ICD10CM | Drug or chemical induced diabetes mellitus without complications |
| E11 | ICD10CM | Type 2 diabetes mellitus |
| E11.0 | ICD10CM | Type 2 diabetes mellitus with hyperosmolarity |
| E11.00 | ICD10CM | Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHc) |
| E11.01 | ICD10CM | Type 2 diabetes mellitus with hyperosmolarity with coma |
| E11.1 | ICD10CM | Type 2 diabetes mellitus with ketoacidosis |
| E11.10 | ICD10CM | Type 2 diabetes mellitus with ketoacidosis without coma |
| E11.11 | ICD10CM | Type 2 diabetes mellitus with ketoacidosis with coma |
| E11.2 | ICD10CM | Type 2 diabetes mellitus with kidney complications |
| E11.21 | ICD10CM | Type 2 diabetes mellitus with diabetic nephropathy |
| E11.22 | ICD10CM | Type 2 diabetes mellitus with diabetic chronic kidney disease |
| E11.29 | ICD10CM | Type 2 diabetes mellitus with other diabetic kidney complication |
| E11.3 | ICD10CM | Type 2 diabetes mellitus with ophthalmic complications |
| E11.31 | ICD10CM | Type 2 diabetes mellitus with unspecified diabetic retinopathy |
| E11.311 | ICD10CM | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E11.319 | ICD10CM | Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| E11.32 | ICD10CM | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy |
| E11.321 | ICD10CM | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema |
| E11.3211 | ICD10CM | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E11.3212 | ICD10CM | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E11.3213 | ICD10CM | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E11.3219 | ICD10CM | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E11.329 | ICD10CM | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema |
| E11.3291 | ICD10CM | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| E11.3292 | ICD10CM | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| E11.3293 | ICD10CM | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| E11.3299 | ICD10CM | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.33 | ICD10CM | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy |
| E11.331 | ICD10CM | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema |
| E11.3311 | ICD10CM | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E11.3312 | ICD10CM | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E11.3313 | ICD10CM | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E11.3319 | ICD10CM | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E11.339 | ICD10CM | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema |
| E11.3391 | ICD10CM | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| E11.3392 | ICD10CM | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| E11.3393 | ICD10CM | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| E11.3399 | ICD10CM | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.34 | ICD10CM | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy |
| E11.341 | ICD10CM | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema |
| E11.3411 | ICD10CM | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E11.3412 | ICD10CM | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E11.3413 | ICD10CM | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E11.3419 | ICD10CM | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E11.349 | ICD10CM | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema |
| E11.3491 | ICD10CM | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| E11.3492 | ICD10CM | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| E11.3493 | ICD10CM | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| E11.3499 | ICD10CM | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.35 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy |
| E11.351 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema |
| E11.3511 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| E11.3512 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| E11.3513 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| E11.3519 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E11.352 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula |
| E11.3521 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E11.3522 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E11.3523 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E11.3529 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E11.353 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula |
| E11.3531 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E11.3532 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E11.3533 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E11.3539 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E11.354 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment |
| E11.3541 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E11.3542 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E11.3543 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E11.3549 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E11.355 | ICD10CM | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy |
| E11.3551 | ICD10CM | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
| E11.3552 | ICD10CM | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
| E11.3553 | ICD10CM | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
| E11.3559 | ICD10CM | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
| E11.359 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema |
| E11.3591 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| E11.3592 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| E11.3593 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| E11.3599 | ICD10CM | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.36 | ICD10CM | Type 2 diabetes mellitus with diabetic cataract |
| E11.37 | ICD10CM | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment |
| E11.37x1 | ICD10CM | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
| E11.37x2 | ICD10CM | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
| E11.37x3 | ICD10CM | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
| E11.37x9 | ICD10CM | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
| E11.39 | ICD10CM | Type 2 diabetes mellitus with other diabetic ophthalmic complication |
| E11.4 | ICD10CM | Type 2 diabetes mellitus with neurological complications |
| E11.40 | ICD10CM | Type 2 diabetes mellitus with diabetic neuropathy, unspecified |
| E11.41 | ICD10CM | Type 2 diabetes mellitus with diabetic mononeuropathy |
| E11.42 | ICD10CM | Type 2 diabetes mellitus with diabetic polyneuropathy |
| E11.43 | ICD10CM | Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy |
| E11.44 | ICD10CM | Type 2 diabetes mellitus with diabetic amyotrophy |
| E11.49 | ICD10CM | Type 2 diabetes mellitus with other diabetic neurological complication |
| E11.5 | ICD10CM | Type 2 diabetes mellitus with circulatory complications |
| E11.51 | ICD10CM | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E11.52 | ICD10CM | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E11.59 | ICD10CM | Type 2 diabetes mellitus with other circulatory complications |
| E11.6 | ICD10CM | Type 2 diabetes mellitus with other specified complications |
| E11.61 | ICD10CM | Type 2 diabetes mellitus with diabetic arthropathy |
| E11.610 | ICD10CM | Type 2 diabetes mellitus with diabetic neuropathic arthropathy |
| E11.618 | ICD10CM | Type 2 diabetes mellitus with other diabetic arthropathy |
| E11.62 | ICD10CM | Type 2 diabetes mellitus with skin complications |
| E11.620 | ICD10CM | Type 2 diabetes mellitus with diabetic dermatitis |
| E11.621 | ICD10CM | Type 2 diabetes mellitus with foot ulcer |
| E11.622 | ICD10CM | Type 2 diabetes mellitus with other skin ulcer |
| E11.628 | ICD10CM | Type 2 diabetes mellitus with other skin complications |
| E11.63 | ICD10CM | Type 2 diabetes mellitus with oral complications |
| E11.630 | ICD10CM | Type 2 diabetes mellitus with periodontal disease |
| E11.638 | ICD10CM | Type 2 diabetes mellitus with other oral complications |
| E11.64 | ICD10CM | Type 2 diabetes mellitus with hypoglycemia |
| E11.641 | ICD10CM | Type 2 diabetes mellitus with hypoglycemia with coma |
| E11.649 | ICD10CM | Type 2 diabetes mellitus with hypoglycemia without coma |
| E11.65 | ICD10CM | Type 2 diabetes mellitus with hyperglycemia |
| E11.69 | ICD10CM | Type 2 diabetes mellitus with other specified complication |
| E11.8 | ICD10CM | Type 2 diabetes mellitus with unspecified complications |
| E11.9 | ICD10CM | Type 2 diabetes mellitus without complications |
| E13 | ICD10CM | Other specified diabetes mellitus |
| E13.0 | ICD10CM | Other specified diabetes mellitus with hyperosmolarity |
| E13.00 | ICD10CM | Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHc) |
| E13.01 | ICD10CM | Other specified diabetes mellitus with hyperosmolarity with coma |
| E13.1 | ICD10CM | Other specified diabetes mellitus with ketoacidosis |
| E13.10 | ICD10CM | Other specified diabetes mellitus with ketoacidosis without coma |
| E13.11 | ICD10CM | Other specified diabetes mellitus with ketoacidosis with coma |
| E13.2 | ICD10CM | Other specified diabetes mellitus with kidney complications |
| E13.21 | ICD10CM | Other specified diabetes mellitus with diabetic nephropathy |
| E13.22 | ICD10CM | Other specified diabetes mellitus with diabetic chronic kidney disease |
| E13.29 | ICD10CM | Other specified diabetes mellitus with other diabetic kidney complication |
| E13.3 | ICD10CM | Other specified diabetes mellitus with ophthalmic complications |
| E13.31 | ICD10CM | Other specified diabetes mellitus with unspecified diabetic retinopathy |
| E13.311 | ICD10CM | Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E13.319 | ICD10CM | Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| E13.32 | ICD10CM | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy |
| E13.321 | ICD10CM | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema |
| E13.3211 | ICD10CM | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E13.3212 | ICD10CM | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E13.3213 | ICD10CM | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E13.3219 | ICD10CM | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E13.329 | ICD10CM | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema |
| E13.3291 | ICD10CM | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| E13.3292 | ICD10CM | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| E13.3293 | ICD10CM | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| E13.3299 | ICD10CM | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E13.33 | ICD10CM | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy |
| E13.331 | ICD10CM | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema |
| E13.3311 | ICD10CM | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E13.3312 | ICD10CM | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E13.3313 | ICD10CM | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E13.3319 | ICD10CM | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E13.339 | ICD10CM | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema |
| E13.3391 | ICD10CM | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| E13.3392 | ICD10CM | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| E13.3393 | ICD10CM | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| E13.3399 | ICD10CM | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E13.34 | ICD10CM | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy |
| E13.341 | ICD10CM | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema |
| E13.3411 | ICD10CM | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E13.3412 | ICD10CM | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E13.3413 | ICD10CM | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E13.3419 | ICD10CM | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E13.349 | ICD10CM | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema |
| E13.3491 | ICD10CM | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| E13.3492 | ICD10CM | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| E13.3493 | ICD10CM | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| E13.3499 | ICD10CM | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E13.35 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy |
| E13.351 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema |
| E13.3511 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| E13.3512 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| E13.3513 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| E13.3519 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E13.352 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula |
| E13.3521 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E13.3522 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E13.3523 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E13.3529 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E13.353 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula |
| E13.3531 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E13.3532 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E13.3533 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E13.3539 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E13.354 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment |
| E13.3541 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E13.3542 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E13.3543 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E13.3549 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E13.355 | ICD10CM | Other specified diabetes mellitus with stable proliferative diabetic retinopathy |
| E13.3551 | ICD10CM | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
| E13.3552 | ICD10CM | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
| E13.3553 | ICD10CM | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
| E13.3559 | ICD10CM | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
| E13.359 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema |
| E13.3591 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| E13.3592 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| E13.3593 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| E13.3599 | ICD10CM | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E13.36 | ICD10CM | Other specified diabetes mellitus with diabetic cataract |
| E13.37 | ICD10CM | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment |
| E13.37x1 | ICD10CM | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
| E13.37x2 | ICD10CM | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
| E13.37x3 | ICD10CM | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
| E13.37x9 | ICD10CM | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
| E13.39 | ICD10CM | Other specified diabetes mellitus with other diabetic ophthalmic complication |
| E13.4 | ICD10CM | Other specified diabetes mellitus with neurological complications |
| E13.40 | ICD10CM | Other specified diabetes mellitus with diabetic neuropathy, unspecified |
| E13.41 | ICD10CM | Other specified diabetes mellitus with diabetic mononeuropathy |
| E13.42 | ICD10CM | Other specified diabetes mellitus with diabetic polyneuropathy |
| E13.43 | ICD10CM | Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy |
| E13.44 | ICD10CM | Other specified diabetes mellitus with diabetic amyotrophy |
| E13.49 | ICD10CM | Other specified diabetes mellitus with other diabetic neurological complication |
| E13.5 | ICD10CM | Other specified diabetes mellitus with circulatory complications |
| E13.51 | ICD10CM | Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E13.52 | ICD10CM | Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E13.59 | ICD10CM | Other specified diabetes mellitus with other circulatory complications |
| E13.6 | ICD10CM | Other specified diabetes mellitus with other specified complications |
| E13.61 | ICD10CM | Other specified diabetes mellitus with diabetic arthropathy |
| E13.610 | ICD10CM | Other specified diabetes mellitus with diabetic neuropathic arthropathy |
| E13.618 | ICD10CM | Other specified diabetes mellitus with other diabetic arthropathy |
| E13.62 | ICD10CM | Other specified diabetes mellitus with skin complications |
| E13.620 | ICD10CM | Other specified diabetes mellitus with diabetic dermatitis |
| E13.621 | ICD10CM | Other specified diabetes mellitus with foot ulcer |
| E13.622 | ICD10CM | Other specified diabetes mellitus with other skin ulcer |
| E13.628 | ICD10CM | Other specified diabetes mellitus with other skin complications |
| E13.63 | ICD10CM | Other specified diabetes mellitus with oral complications |
| E13.630 | ICD10CM | Other specified diabetes mellitus with periodontal disease |
| E13.638 | ICD10CM | Other specified diabetes mellitus with other oral complications |
| E13.64 | ICD10CM | Other specified diabetes mellitus with hypoglycemia |
| E13.641 | ICD10CM | Other specified diabetes mellitus with hypoglycemia with coma |
| E13.649 | ICD10CM | Other specified diabetes mellitus with hypoglycemia without coma |
| E13.65 | ICD10CM | Other specified diabetes mellitus with hyperglycemia |
| E13.69 | ICD10CM | Other specified diabetes mellitus with other specified complication |
| E13.8 | ICD10CM | Other specified diabetes mellitus with unspecified complications |
| E13.9 | ICD10CM | Other specified diabetes mellitus without complications |
ICD code information from First Databank (FDB).
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