Exenatide - Byetta to Bydureon
Transition from Byetta twice daily injections to Bydureon once a week injection. Following weekly administration of 2 mg exenatide once weekly, there is a gradual increase in the average plasma exenatide concentration over 6 to 7 weeks.
Customers monitoring blood glucose levels may experience a rise in blood glucose due to the long-acting nature of Bydureon.
Interventions:
- Counselling on what to expect is appropriate at this point.
- Diabetes MedsCheck
- Referral to appropriate health care team.
Exenatide - Discontinuing Bydureon.
A rise in blood glucose may be seen when discontinuing Bydureon. In some individuals it may take up to 10 weeks after discontinuation of Bydureon before side effects have ceased.
Interventions:
- Counselling of what to expect is appropriate at this point.
- Diabetes MedsCheck
- Referral to appropriate health care team
Exenatide - Bydureon
After suspension, Bydureon should be administered immediately into the abdomen as a subcutaneous injection. Do not administer intravenously or intramuscularly.
Interventions:
- Diabetes MedsCheck with counselling on how to use Bydureon pen.
- Referral to healthcare team if required.
Hypoglycaemia
GLP1 Analogues do not cause hypoglycaemia alone, however, when used in conjunction with sulfonylureas or insulin hypoglycaemia can occur.
Interventions:
- Diabetes MedsCheck for side effect profile
- Referral to healthcaqre team.
- Education on managing hypoglycaemia.
Dulaglutide - Injections
Trulicity should be injected subcutaneously in the abdomen, thigh, or upper arm. Do not inject Trulicity intravenously or intramuscularly.
Interventions:
- Diabetes MedsCheck and how to use pen.
Semaglutide - Diabetic Retinopathy
In individuals with diabetic retinopathy treated with insulin and semaglutide, an increased risk of developing diabetic retinopathy complications has been observed. Caution should be used.
Interventions:
- Diabetes MedsCheck with referral for annual cycle of care.
- Referral to appropriate health care professionals including GP for EPC visit.
Saxenda
The use of Saxenda does not replace physical activity and healthy eating.
Interventions:
- MedsCheck is useful; unless the individual has been diagnosed with diabetes and then a Diabetes MedsCheck can be activated to engage in consultation and referral for appropriate health care professionals.
Acute pancreatitis
Pancreatitis has been reported with use GLP-1 receptor agonists. Patients should be informed of the symptoms of acute pancreatitis. If acute pancreatitis is suspected, consider discontinuation until evaluation is completed.
Interventions:
- Diabetes MedsCheck for side effect profile and prevention of complications.
- Referral to appropriate allied healthcare team.
Gastric Emptying
The delay of gastric emptying with GLP-1 Analogues may influence the absorption of many medications. All should be used with caution where medicinal products require rapid gastrointestinal absorption.
Interventions:
- Diabetes MedsCheck
- Referral to healthcare team
Needle Supply
- Trulicity is supplied with its own needles. There is no need therefore, to update the status of the NDSS.
- Ozempic (both strengths) are supplied with their own needles. There is no need therefore, to update the status of the NDSS.
- The Saxenda pen is designed to be used with NovoFine disposable needles up to a length of 8 mm. It is however generally recommended that NovoFine 6mm needles are used. Injection needles are not included. NovoNordisk supply needles free with the first prescription and the sixth prescription through the Saxenda program
https://saxenda.pharmaprograms.com.au/home/
Individuals should be advised to discard the injection needle after each injection and store the pen without a needle attached. This may prevent blocked needles, contamination, infection, leakage of solution and inaccurate dosing. - Needles are not supplied with Victoza under the NDSS (due to Victoza being considered a private non-PBS prescription). Needles will need to be purchased from the pharmacy. NovoNordisk recommend 6mm or 4mm. A Diabetes MedsCheck can be useful with guidance on how to use Victoza pen, referral to Credentialled Diabetes Educator on injection technique.
Interventions:
- Guidance – Safe disposal of needles.