| Management |
To reduce the risk of hypoglycemia, it is recommended that mealtime insulin doses be decreased by 50% when initiating pramlintide. Blood glucose should be monitored frequently, including pre- and post-meals and at bedtime, particularly upon initiation of pramlintide therapy and following a dose increase. After the initial 50% reduction in mealtime insulin dose, further adjustments of insulin dose should be individualized based on glycemic control and tolerability of the antidiabetic regimen. An increased frequency of mild-to-moderate hypoglycemia should be viewed as a warning sign of increased risk for severe hypoglycemia. Pramlintide should be discontinued if a patient experiences recurrent unexplained hypoglycemia that requires medical assistance. If pramlintide therapy is temporarily discontinued for any reason (e.g., surgery or illnesses), the same initiation protocol should be followed when therapy is reinstituted. |
