Problem:
KF is a 73 year old woman with a complicated medical history including migraine, osteoporosis with history of fracture), hypertension and heart failure with reduced ejection fraction (for which she has had multiple recent exacerbations requiring hospitalization). She also has diabetes and is on a regimen consisting of the following medications: repaglinide (Prandin) 0.5 mg 30 minutes before meals and pioglitazone (Actos) 30mg once daily by mouth. Her CHF exacerbations (including shortness of breath, volume overlaod and edema) are becoming more frequent.
What initial change do you want to make to her DM medications in light of worsening heart failure?