GLP-1 receptor agonists lower glucose in a glucose-dependent way and rarely cause hypoglycaemia alone. Added to a sulfonylurea or insulin, they can. The usual approach is to reduce the sulfonylurea dose, or stop it if HbA1c is near target, and to trim basal insulin when starting, then adjust with home glucose readings. Titrate the incretin slowly, eat smaller meals, and stop eating when full to limit nausea. Persistent vomiting with poor intake is a reason to pause any SGLT2 inhibitor and check for dehydration.
- Reduce or stop the sulfonylurea when an incretin is started, depending on HbA1c.
- Lower basal insulin modestly at the start and review home glucose within two weeks.
- Advise small meals and slow dose steps to limit nausea.
- With persistent vomiting, pause SGLT2 inhibitors and assess hydration.
Why it matters
Most early incretin failures are hypoglycaemia or nausea that a dose plan would have prevented.
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