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Lifestyle Interventions (First-Line) Dietary modification: Caloric restriction, specific dietary patterns (Mediterranean, low-carbohydrate, DASH)

It has been helpful in limiting the use of prednisone and in helping avoid severe flares of the illness, says Kramer

Scrocchi, L.A

Severe Allergic Reactions (Anaphylaxis/Severe Hypersensitivity): Symptoms : Swelling of face, lips, tongue, or throat Difficulty breathing or swallowing Severe rash or hives covering large body areas Rapid heartbeat Severe dizziness or lightheadedness Loss of consciousness Action Required : Call 911 immediately - this is life-threatening emergency Use epinephrine auto-injector if available (EpiPen) Do not attempt to drive yourself Inform emergency responders about GLP-1 medication Incidence : Very rare (less than 0.1% of users) Future Use : If severe allergic reaction occurs, cannot use that medication or potentially any GLP-1 medication again Hypoglycemia (Low Blood Sugar): Symptoms : Shakiness or trembling Sweating (cold sweat) Rapid heartbeat or palpitations Dizziness or lightheadedness Hunger Irritability or mood changes Confusion or difficulty concentrating Blurred vision Weakness or fatigue Headache Action Required : Check blood glucose if glucometer available Consume 15-20 grams fast-acting carbohydrates immediately: 4 glucose tablets 4 ounces fruit juice 5-6 pieces hard candy 1 tablespoon honey or sugar Recheck glucose in 15 minutes If still low, repeat treatment Contact healthcare provider same day If severe (unconscious, seizure), call 911 Risk Factors : PRIMARY RISK : Taking GLP-1 medication WITH other diabetes medications that cause hypoglycemia: Insulin (any type) Sulfonylureas (glipizide, glyburide, glimepiride) Meglitinides (repaglinide, nateglinide) GLP-1 medications alone rarely cause hypoglycemia because they're glucose-dependent (only work when glucose elevated) Prevention : Healthcare provider should reduce insulin or sulfonylurea doses when starting GLP-1 medication Monitor blood glucose closely during first weeks Coordinate with diabetes care team Acute Kidney Injury : Symptoms : Decreased urination or no urination Swelling in legs, ankles, feet, face Fatigue or weakness Shortness of breath Confusion or difficulty thinking clearly Nausea Irregular heartbeat Action Required : Contact healthcare provider immediately May require urgent evaluation with lab work May require hospitalization Risk Factors : Severe dehydration (from vomiting or diarrhea) Pre-existing kidney disease Certain medications (NSAIDs, ACE inhibitors, diuretics) Older age Prevention : Maintain adequate hydration, especially during dose increases Monitor for severe GI symptoms Inform provider of any existing kidney disease Diabetic Retinopathy Worsening : Symptoms : Blurred vision or vision changes Floaters (spots in vision) Flashes of light Dark areas or blind spots in vision Difficulty seeing at night Action Required : Contact both healthcare provider AND eye doctor (ophthalmologist) Requires dilated eye examination May require treatment to prevent vision loss Risk Factors : Pre-existing diabetic retinopathy Rapid improvement in blood glucose control Poor glucose control prior to treatment Mechanism : Rapid blood glucose improvements can temporarily worsen retinopathy (paradoxical effect) Prevention : Gradual dose escalation

"It kind of numbs you," she said

Abstract Glucagon-like peptide-1 (GLP-1) reduces insulin requirement in diabetes mellitus and promotes satiety