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Key Points: - GLP-1 is the first-line injectable for poorly controlled type II diabetes, preferred over insulin due to its favorable metabolic profile. - When adding a GLP-1 to a patient already on insulin: - If blood sugar is well controlled (Hgb A1c less than 8% or time in range greater than 50%), reduce insulin by 20%. - If blood sugar is not well controlled (Hgb A1c greater than 8% or time in range less than 50%), start GLP-1 without adjusting insulin. - As GLP-1 dosage increases, insulin needs typically decrease. - SGLT2 inhibitors have a less potent effect on glucose but may warrant insulin dose reduction. Core IM interviews Dr. Tom Martens who explains how he goes about adjusting insulin regimens as he adds GLP-1 or SGLT2is to diabetes regimens. Although he explains that GLP-1 therapy is now first line therapy for type 2 diabetes, he provides insight on how to add on these treatments in patients previously prescribed insulin while mitigating risk of hypoglycemia. Credits: Discussant: Dr. Tom Martens Interview: Dr. Rebecca Easly-Merski Video: Jason Krastein & Dr. Alice Kennedy #continuousglucosemonitor, #cgm, #insulin, #glp1, #endocrinology, #diabetes, #prevention, #primarycare, #internalmedicine, #medicaleducation, #residency, #CoreIM, #IMcore

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