I have had several patients who did well at first with their GLP-1 agonists.
Patient 1: Man, 46 years of age, used liraglutide 3mg daily for obesity.
Patients 2 & 3: 2 women in their 60s were using liraglutide for type 2 diabetes & weight.
Patient 1: Reported a good response to the liraglutide. Was titrating up. Reported a red hard area at the site. Sent me a picture. I asked if he switched sites. He said no. He reported that it did not start looking like that until he went up to the 1.8mg dose. I recommended he skip that site and instructed him about site rotation. No further complaints or skin problems.
Patients 2 & 3. Patients were rotating sites. They each complained of the areas being red and itchy, as if they were insect bites.
For both I recommended they change brand of pen needles.
Patient 2 did well. No further skin issues.
Patient 3 continued to have local reaction. We changed her to exenatide. No further issues. We later switched her over to dulaglitide. No further issues.
Disasters averted on all three-they were able to continue with a treatment that was helping them.
- Always teach patients to rotate sites when teaching the use of any injectable medication except when not appropriate.
- Always look at sites when patient visits.
- If patient seems to be having a site reaction-check that they are rotating sites. If not, teach them how to rotate sites.
- If patient seems to be having a site reaction, but is responding well to the treatment, change needle brands and the pen itself to see if this helps. If not, and if appropriate-switch GLP-1 to see if patient tolerates that. And, BTW-if patient has reaction to dulaglutide, wait until one week from last injection before making the switch.
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