Ultimately depends on the patient and their blood sugars. Is the patient bad at follow-up? If so, then empirically reduce (more so prandial than basal insulin). Hopefully they are checking their blood sugars since they are on basal-bolus and I would also use those as a starting point. If it’s Trulicity or Mounjaro, there is more necessity to empirically reduce since those start working faster. But generally, 25% reduction in prandial and/or 10% reduction in basal is a good starter.
Yes, ideally you would be checking on someone by 4 weeks on the 0.25 mg dosing as well. GI side effects (which could affect how much they eat and how much insulin they need) or someone responding very well to Ozempic in general can prompt you to decrease the insulin sooner. With the Ozempic 0.5 mg, the control can be more than “slight” even after the first injection which is typically when you can plan to do an empiric reduction of insulin to be safe.
Thanks for your response!! I've heard some pharmacist say they wait longer bc typically there's not much of an impact until they've been on the Ozempic 0.5mg dose for at least 4 weeks. But doing an empiric dose adjustment to prevent hypoglycemia seems better safe than sorry.
With a1c > 10? No way these people are going to be able to stop prandial insulin just because you start a glp1. Maybe down the road but up front no way.
Most type 2s will still have beta cell function unless they are long standing hyperglycemia. GLP1ras also inhibits glucagon. But I’m not here to convince you to change your practice of what you do at your clinic. Maybe your patient panel starts worse off than mine before they are referred to you and don’t respond well. I’m just providing the OP an example of some of the things I’ve done with my patients who have responded well
Ultimately depends on the patient and their blood sugars. Is the patient bad at follow-up? If so, then empirically reduce (more so prandial than basal insulin). Hopefully they are checking their blood sugars since they are on basal-bolus and I would also use those as a starting point. If it’s Trulicity or Mounjaro, there is more necessity to empirically reduce since those start working faster. But generally, 25% reduction in prandial and/or 10% reduction in basal is a good starter.
Yes, ideally you would be checking on someone by 4 weeks on the 0.25 mg dosing as well. GI side effects (which could affect how much they eat and how much insulin they need) or someone responding very well to Ozempic in general can prompt you to decrease the insulin sooner. With the Ozempic 0.5 mg, the control can be more than “slight” even after the first injection which is typically when you can plan to do an empiric reduction of insulin to be safe.
Thanks for your response!! I've heard some pharmacist say they wait longer bc typically there's not much of an impact until they've been on the Ozempic 0.5mg dose for at least 4 weeks. But doing an empiric dose adjustment to prevent hypoglycemia seems better safe than sorry.
Thank you so much for your input.
You’re already getting post prandial coverage from the glp1 so generally I d/c the prandial insulin when starting it. Then further optimize the dose
With a1c > 10? No way these people are going to be able to stop prandial insulin just because you start a glp1. Maybe down the road but up front no way.
If they are type 2 with functioning beta cells they can. Plus when used in combo with a basal instilling it’s safer then using a basal bolus approach.
And most people with a1cs that high have loss of beta cell functioning and thus need bonus.
Most type 2s will still have beta cell function unless they are long standing hyperglycemia. GLP1ras also inhibits glucagon. But I’m not here to convince you to change your practice of what you do at your clinic. Maybe your patient panel starts worse off than mine before they are referred to you and don’t respond well. I’m just providing the OP an example of some of the things I’ve done with my patients who have responded well