Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-31 Dosage adjustment is recommended if: • eGFR 30-59 mL/min/1.73m 2 : lower dose to 5mcg bid Contraindication • ESRD or eGFR <30 mL/min/1.73m 2 , and pancreatitis Each prefilled pen will deliver: • 1.2 mL prefilled pen (delivers 60 doses of 5 μg /dose) • 2.4 mL prefilled pen (delivers 60 doses of 10 μ g/dose) • Needle not included.

Exenatide (Byetta ® ) Short-acting GLP-1 Analogue isolated from the saliva of the gila monster lizard. It has a 53% homology (resemblance) to human GLP-1. • TDD: 10 μg - 20 μg • Frequency: BID • Taken <60 minutes before meals (breakfast and dinner); at least 6 hours apart. Dosing schedule • Initiate at 5 μg sc BID. • Titrate dose to 10 μg BID after 1 month of therapy if tolerating well. • Do not take if dose was missed. Dose that has demonstrated cardiorenal benefits: • Exenatide BID has demonstrated CV safety, but not CV benefit Lixisenatide Available in Canada in fixed-dose combination with insulin glargine U100 (Soliqua®) Short-acting GLP-1 Analogue with 50% homology (resemblance) to human GLP-1. • TDD: 10ug - 20ug • Frequency: QD • administer within 1 hour before the first meal of the day, preferably the same meal each day. Dosing schedule • If currently 0 – 30 units of basal insulin/day: start 15 units (insulin glargine 15 units/lixisenatide 5 mcg) sc qd • If currently 30 – 60 units of basal insulin/day: start 30 units (insulin glargine 30 units/lixisenatide 10 mcg) sc qd

Contraindication •

if eGFR <30 mL/min/1.73m 2

Titrate by 2 to 4 units every week until target FBG is achieved. Maximum dose: 60 units