Blood Glucose Management on GLP-1: Safety Protocol

If you have Type 2 diabetes and use other medications, GLP-1 changes your glucose risk. This guide covers medication adjustments and hypoglycemia prevention.

The Core Issue: Drug Interactions

GLP-1 lowers blood glucose by 2 mechanisms:

• Increases insulin secretion when glucose is high (safe - only works high)
• Slows digestion (extends fullness, stabilizes glucose)

Problem: If you're also on OTHER drugs that lower glucose (sulfonylureas, insulin, SGLT2 inhibitors), combined effect = too much glucose lowering = hypoglycemia (dangerously low blood sugar).

Solution: Doctor reduces OTHER medications when starting GLP-1. Not stopping them - reducing doses.

High-Risk Medications

These require dose reduction when starting GLP-1:

Sulfonylureas (Glibenclamide, Glipizide)

Insulin (Basal or Bolus)

SGLT2 Inhibitors (Dapagliflozin, Empagliflozin)

Metformin

DPP-4 Inhibitors (Sitagliptin, Vildagliptin)

Hypoglycemia: What It Is & What To Do

Symptoms of Low Blood Sugar (<70 mg/dL)

Early Warning Signs (mild, 60-70 mg/dL):

• Feeling shaky
• Sweating
• Anxiety
• Rapid heartbeat
• Hunger

Moderate Hypoglycemia (50-60 mg/dL):

• Confusion
• Difficulty concentrating
• Blurred vision
• Difficulty speaking

Severe Hypoglycemia (<50 mg/dL):

• Loss of consciousness
• Seizures
• Death (rare but real)

EMERGENCY: If severe hypoglycemia, seek immediate medical care (call 911 equivalent, hospital emergency).

Treatment: The 15-15 Rule

If you feel hypoglycemia symptoms:

1. Check blood glucose if possible (glucose meter)
2. If <70 mg/dL (or can't check), consume 15g fast carbs immediately:
   • 3 glucose tablets
   • 120mL fruit juice
   • 3-4 spoonfuls sugar
   • 5-6 candies
3. Wait 15 minutes
4. Recheck glucose
5. If still low, repeat step 2-4
6. Once glucose >100 mg/dL, eat real food (protein + carbs) to stabilize

Keep fast carbs always accessible: glucose tablets in bag, car, office, bedside.

Monitoring Protocol for Diabetics

Before Starting GLP-1:

• Get baseline glucose meter (finger-stick) or continuous glucose monitor (CGM)
• Know how to use it
• Test fasting glucose + random glucose daily x 3 days

Weeks 1-4 (High Risk Period):

• Test fasting glucose DAILY
• Test before meals
• Test 2 hours after meals
• Test before bed
• Log all readings
• Contact doctor IMMEDIATELY if any reading <100 mg/dL fasting

Weeks 5-12:

• Test fasting daily
• Test before lunch and dinner
• Less frequent (3-4 times daily)
• Weekly check-in with doctor

Week 12+ (Stable):

• Test fasting 2-3 times weekly
• Random glucose 2-3 times weekly
• Monthly lab work (A1C, lipids)
• Quarterly doctor check-in

Medication Adjustment Protocol

Red Flags: When to Contact Doctor Immediately

Non-Diabetics on GLP-1 (Still Important)

If you DON'T have diabetes: Risk of hypoglycemia is very low (GLP-1 only works when glucose is high). BUT:

• If you feel shaky/sweaty after skipping meals, it could be low glucose
• Have glucose tablets on hand anyway (better safe)
• Eating regular meals prevents problem

Lagos Medical Support

EkoPeptide doctors:

• Review your current diabetes medications at screening
• Recommend which ones to reduce/stop before GLP-1 start
• Coordinate with your existing doctor (if you have one)
• Monitor glucose readings weekly first month
• Adjust medications as glucose drops
• Provide WhatsApp support for hypoglycemia questions