Table 4. Summary of Priority Topics (continued)
For individuals who take α-glucosidase inhibitors:
• Gradually titrate to minimize gastrointestinal side effects when initiating use.
• Take at start of meal to have maximal effect:
▶ If taking along with an insulin secretagogue or insulin, may experience hypoglycemia.
▶ If hypoglycemia occurs, eat something containing monosaccharides such as glucose
tablets, since the drug will prevent the digestion of polysaccharides.
For individuals who take incretin mimetics (GLP-1s):
• Gradually titrate to minimize gastrointestinal side effects when initiating use:
▶ Injection of daily or twice-daily GLP-1s should be premeal.
▶ If side effects do not resolve over time (a few weeks), follow up with health care
provider.
▶ If taking along with an insulin secretagogue or insulin, may experience hypoglycemia.
a
▶ Once-weekly GLP-1s can be taken at any time during the day regardless of meal times.
For individuals with type 1 diabetes and insulin-requiring type 2 diabetes:
• Learn how to count carbohydrates or use another meal planning approach to quantify
carbohydrate intake. The objective of using such a meal planning approach is to "match"
mealtime insulin to carbohydrates consumed.
• If on a multiple-daily injection plan or on an insulin pump:
▶ Take mealtime insulin before eating.
▶ Meals can be consumed at different times.
▶ If physical activity is performed within 1-2 h of mealtime insulin injection, this dose
may need to be lowered to reduce risk of hypoglycemia.*
• If on a premixed insulin plan:
▶ Insulin doses need to be taken at consistent times every day.
▶ Meals need to be consumed at similar times every day.
▶ Do not skip meals to reduce risk of hypoglycemia.
▶ Physical activity may result in low blood glucose depending on when it is performed.
Always carry a source of quick-acting carbohydrates to reduce risk of hypoglycemia.
a
• If on a fixed insulin plan:
▶ Eat similar amounts of carbohydrates each day to match the set doses of insulin.
a
Treatment of hypoglycemia: current recommendations include the use of glucose tablets or carbohydrate-
containing foods or beverages (such as fruit juice, sports drinks, regular soda pop, or hard candy) to treat
hypoglycemia. A commonly recommended dose of glucose is 15-20 g. When blood glucose levels are
~50-60 mg/dL, treatment with 15 g of glucose can be expected to raise blood glucose levels ~50 mg/dL.
If self-monitoring of blood glucose about 15-20 min aer treatment shows continued hypoglycemia, the
treatment should be repeated.
