**4.4 Medication for diabetes**

The most important medications to reduce or eliminate first are those that lower blood glucose. The most serious concern we have with TCR in patients with blood sugar problems is that it will cause symptomatic hypoglycemia. As a result, the most important point to emphasize is the importance of blood glucose monitoring regularly. This means that insulin users must test several times throughout the day, including fasting and pre-meal tests. If you are only taking oral medications, you might have to test once or twice a day.

The degree to which we reduce or discontinue medications is determined by the wishes and concerns of our patients. For example, if avoiding hypoglycemia is more important, we can quickly lower drugs and temporarily allow higher blood glucose levels. We would adjust medications more slowly if the patient is more concerned about maintaining strict glucose control. The most important thing is to teach the patient about hypoglycemia symptoms and the importance of testing their blood glucose multiple times per day, especially in the first few weeks.
