An Educator's Perspective: Michelle Laine, A.R.N.P., C.D.E.

I will also use the GLP-1 analogs with basal insulin and when I start a patient on a GLP-1 analog I will decrease the dose of basal insulin and when they are ready to move to the maximum dose I often am able to discontinue the basal insulin altogether.

My choice of GLP-1 analogs is often dictated by the insurance company formulary but I am always trying to push to the once a day product as I believe that this aids in adherence and gives patients who would be embarrassed to inject in front of others the ability to have control.

Since I am also a CDE I do a lot of the education on GLP-1 analog therapy, and also include food choices and the use of monitoring with the GLP-1 analogs. I focus on two major points with food therapy, lower carbohydrates and reduced fat. I advise the reduced fat during the first couple of months.

Experience has shown me that by decreasing the fat during the first couple of months helps reduce the chances of nausea. Our endocrinologists also prescribe GLP-1 analogs and they refer most of their patients to the in-office diabetes educator who educates in the same method as I do. We both have found that the twice a day GLP-1 analog has a greater nausea potential and we often have the patient start by taking it closer to the meal and backing it away as they get used to the medication and I also have found that having the patient melt an Ice Breaker Sour in their mouth when they feel nauseas will help.

 

 

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I've also found that explaining to the patient that they will get this feeling of fullness and how this helps them understand when to "push back" from the table.

When it comes to monitoring my main goal is to have the patient see the benefits of using the GLP-1 analogs and pre- and post-prandial monitoring works well here. I usually start them monitoring before each meal and select one meal each day to check afterwards. After the initial phase I then have them do one meal a day pre and post. I have found that when it comes to measuring success of GLP-1 analogs glucose readings are more important than A1c as the patient can see the results much sooner.

All of us in the five offices do the first injection in the office and so the patient walks out knowing what to expect. We make sure they have a sample to take and also we send the prescription to the pharmacy knowing that most of them may never get the prescription filled if we leave it in their hands and that the pharmacist will call the patient if they have not picked it up. If the patient is getting good results but insurance coverage is a problem we have found that giving them samples for 3 months and getting an A1c will often increase the likelihood that a prior authorization for insurance coverage will be granted.

Michele Lane sees patients along with four endocrinologists in five different locations of the Diabetes Care Centers in the Florida Suncoast Area. She has type 1 diabetes and often is the first professional in her office to recommend GLP-1 analog therapy to her patients.

Interviewed by Dave Joffe, Editor-in-chief, Diabetes In Control

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