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Just Because It Says “—” Doesn’t Mean It Is

Jun 13, 2017

Male, 62 years of age, type 2 diabetes, class III obesity. Has been on metformin, 1,000mg twice daily. Glucose in the 200-300mg/dL range. A1C. Taught about lower carb meal plan, started on Trulicity, first 0.75mg, then 1.5mg/dL. Made the dietary changes right away with the addition of the Trulicity. Within 2 weeks glucose levels averaged 125, patient losing weight, decreased appetite and feeling good. More energy. Insurance did not cover Trulicity, but did cover Victoza, so started on Victoza. When made the change, started with the 0.6mg daily, then increased weekly to the 1.8mg/day.

On the 1.8mg of Victoza, which he took in the morning, he found his appetite was increased later in the day, and he had late afternoon fatigue he did not have before. His fatigue was relieved when he ate something.

We recommended he break his daily dose to 0.9 twice daily, morning and late afternoon. He reported he did not have any further afternoon fatigue and his appetite was more ‘“controlled” throughout the day and evening.

Lessons learned:

  • Just because some medications claim they don’t cause hypoglycemia, or symptoms of hypoglycemia, it may be dose and patient specific. Hypoglycemia, or at least a drop for some people, although not always detected by a fingerstick, can happen.
  • Some medications, such as GLP-1s are not only used for glucose management but also for appetite, weight loss. If patients have symptoms of hypoglycemia, they will eat to feel better and not get the full effect of the medication.
  • Some medications claim to last 24 hours or more, but it can be patient specific.
  • Listen to patients response to medications and work with them to personalize their treatment in a safe and comfortable way.


— Anonymous 


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