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When Adding a GLP-1 for Patients Who Have Type 1 (off label use)

Female 43 years of age. Type 1 diabetes/insulin resistant, hyperglycemia, increasing insulin to manage glucose, but not covering well. Increasing appetite and gaining weight. GLP-1 (Victoza) added at 1/2 recommended start dose for people who have type 2 diabetes, which is 0.6mg, so patient started at 0.3mg daily.

Patient started having hypoglycemic reactions, most often postprandially and nocturnally.  She reported taking her preprandial insulin as she had, but then was so full, she was not able to eat the entire meal she planned for. Recommended she take even a lower amount of Victoza, 0.18mg (3 clicks). We readjusted her basals, boluses, IC ratios and sensitivity.

I also recommended when in doubt, for mealtime insulin, treat for a lower amount of food than she anticipates eating. She did that, and it helped. In this case, she would take less than her recommended amount and did well.

Patient wears a CGM and would send me the reports every 2 to 3 days.

Lessons Learned:

  • GLP-1 analogs are not at this time approved for use in type 1 diabetes.
  • GLP-1 analogs decrease appetite in many people.
  • GLP-1 analogs in patients who have type 1 diabetes are being used off label.
  • Know that some patients who have type 1 diabetes can be very sensitive to GLP-1s.
  • For those patients who start a GLP-1 analog and are on insulin, alert them that their appetite may be much decreased, therefore take less preprandial insulin, or take insulin immediately after they ate knowing how much they actually took.
  • Advise patients who have type 1 to wear CGM to be able to track response and trends so adjustments can be made early on.

Anonymous 

 

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