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First, I try to have most of my patients on continuous glucose monitors (CGM) because if they're on CGM, I can look at the trends to see what's happening as I'm adding a GLP-1 receptor agonist. If they're not on CGM, it's helpful if they test a fasting glucose level and perhaps a postprandial, though it's harder to get people to do, because you want to know whether to reduce the basal insulin or the prandial insulin. Regardless of testing, you need to review with the patient the signs and symptoms of hypoglycemia and how to treat it if it occurs. In a patient on insulin, you may want to make sure they have glucagon at home because there have been episodes of severe hypoglycemia when a GLP-1 receptor agonist was added to insulin. As a rule of thumb, I start by looking at the A1c. If the A1c is above 8%, I'm probably not going to do much reduction in the insulin secretagogue or the insulin right off the bat. I'll watch the patient as they begin to respond to the GLP-1 receptor agonist and then start tapering down the insulin if their glucose levels fall. I often reduce the prandial insulin levels first because you're going to start seeing the patient eating less and be at increased risk for hypoglycemia between meals. If I start seeing the fasting glucose fall, then I'll start reducing the basal insulin. Usually, I reduce the doses by 10%-20%. As I said, in somebody who starts out with a higher A1c, I don't right off the bat reduce the insulin. I watch what happens as the dose is increased. As the dose is increased in someone who's on an oral insulin secretagogue, I'll tend to cut that dose in half as I see glucose levels coming down. On the other hand, if someone's starting A1c is below 8%, I might start by reducing their prandial insulin by 50% and maybe their basal insulin by 10%-20%, depending on their glucose levels. I think patients who are closer to target on insulin and/or a sulfonylurea agent are going to be at increased risk for going low. Ideally, one can taper the patient off their insulin — and if not entirely off their insulin, off their prandial insulin — because it's much easier to give basal insulin and a once-weekly GLP-1 receptor agonist than to be on a multiple daily insulin regimen. Potentially, you'll be able to taper your patient off their insulin secretagogue as well. The important thing to remember is that there's more than one moving target. You're uptitrating the GLP-1 receptor agonist or the GIP/GLP-1 receptor agonist and you're downtitrating the insulin secretagogue and/or the insulin. You want to downtitrate in gradual steps to keep ahead of any risk for hypoglycemia. Usually, that is done in slow steps, say, 10%-20% at a time. It also means that you pay attention to your patients and that you may need to follow them every week or two, particularly if their A1c starts out below 8%, where they're likely to be at more risk for hypoglycemia. If you pay attention to this process, you should be able to get your patient to a better point, hopefully on less medication that can cause hypoglycemia, and onto a medication that not only improves glucose but also helps with weight reduction, improves cardiovascular outcomes, and may have a renal benefit. Thank you. https://www.medscape.com/viewarticle/997976?src=soc_ytSemaglutide Vs Ozempic For Weight Loss Key DifferencesDiscover the shocking dietary consequences of monotonous eating! We explore the dangers of a limited diet and why variety is key to your health. 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Top 10 Best Foods To Eat. https://youtu.be/qVCd2velHMA?si=QqMrOJw_ZtSy3l36 ♥️ Check Out My Favorite Daily Immunity Supplement: NACPRO+ https://nacproplus.com/ Welcome to @HealthyImmuneDoc ▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀ The trauma of working in the frontlines as an acute and critical care Infectious Disease specialist during the chaos and stress of 2020-21, motivated Dr. Liu to promote practical health and wellness principles for her community. HealthyImmuneDoc youtube channel is an extension of her education campaign to help people understand how to optimize immunity and inflammation and slow down premature aging caused by acute and chronic conditions. Everyone is welcome! Dr. Liu’s Bio ▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀ Dr. Liu is the co-founder of NACPro+, dedicated to optimizing immunity and wellness. Dr. Liu graduated from Loma Linda University School of Medicine in 1998 and is Double Boarded in Infectious Disease and Internal Medicine. She is licensed in the state of California. This channel is separate from Dr. Liu’s duties as Attending Medical Staff @ Cedars-Sinai Medical Center and as Assistant Professor at Loma Linda University School of Medicine. The views on this channel are her own. VIDEO TOPICS: ▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀ 00:00 Introduction 00:23 # 1 Mulberries 01:32 Polyphenol List 01:46 # 2 Coffee 02:51 Chlorogenic acid-country of origin 03:57 Autophagy 04:17 Coffee Roasts 04:56 Caffeine 05:13 Condiments for Coffee 05:39 Sumo Wrestlers 07:14 Calories for weight gain 09:02 High Blood Pressure 09:54 Franklin D Roosevelt 10:47 # 3 Cruciferous Vegetables 11:38 Digitalis/Foxglove/Digoxin 12:09 Blood Test 12:51 Blood Pressure Meter 13:58 Rice Diet 15:30 Vital Signs 15:43 High Blood Pressure 17:38 # 4 Seeded Dark Purple Grapes 18:17 Subcutaneous Fat & Metabolism 21:01 Tartaric acid vs cream of tartar 22:03 Food Chemistry vs Food Quality 23:38 Gut Microbiome Effect 24:43 # 5 Cayenne Pepper 25:32 Types of Fat 26:03 Brown Fat 27:13 #6 Blueberry 28:20 Types of Blueberries 29:13 # 7 Raspberries 29:50 # 8 Blackberries 30:46 Washing Berries 31:24 # 9 Black Cumin 32:05 Hepatitis C Virus 33:18 # 10 Apples and Ursolic acid LEGAL DISCLAIMERS: ▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀ Sorry, occupational hazard: This is NOT medical advice, nor can I give you medical advice. I AM NOT YOUR DOCTOR. This video does not create a doctor-patient relationship between Dr. Liu and you. Everything here is for general informational purposes only and not for the purpose of providing medical advice. Information in this video is not intended to be a substitute for professional medical advice and it should not be used to self-diagnose nor should it substitute for a medical exam, treatment, diagnosis, and prescription or other recommendations by a professional medical doctor. You should not make any changes in your health regimen or diet before first consulting a physician. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Users should not disregard or delay in obtaining medical advice from health care professionals for any medical condition. Also, some of the links in this post may be affiliate links, meaning, at no cost to you, I will earn a small commission if you click through and make a purchase. But if you click, it really helps me make more of these videos! All non-licensed clips are used for fair use commentary, criticism, and educational purposes. See Hosseinzadeh v. Klein, 276 F.Supp.3d 34 (S.D.N.Y. 2017); Equals Three, LLC v. Jukin Media, Inc., 139 F. Supp. 3d 1094 (C.D. Cal. 2015).Blue Burn Keto Gummies How They Help With Weight Loss Shark Tank Life Style Keto has taken the world by storm with its innovative approach to ketogenic dieting. This revolutionary product has caught the attention of health enthusiasts and weight watchers alike, offering a unique solution for those looking to achieve their fitness goals. With its all-natural ingredients and proven results, Shark Tank Life Style Keto is changing the way people approach dieting and healthy living. 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