ADDITION OF DULAGLUTIDE FOR A HIGH DOSE INSULIN REQUIRING PATIENT WITH TYPE 2 DIABETES MELLITUS: A REMARKABLE RESPONSE

Introduction Despite the availability of several new classes of anti-diabetic medications, a large proportion of patients with diabetes mellitus fail to achieve optimal glycemic control. Adding glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to basal insulin regimens has shown to improve glycemic control in type 2 diabetes. We present a patient with type 2 diabetes who had marked improvement in glycemic control accompanied by weight loss and a decrease in insulin requirement after adding once weekly dulaglutide to U500 regular insulin. Case A 56-year-old man with type 2 diabetes mellitus, class III obesity (weight 314 lb, BMI 46.4) and hyperlipidemia has had uncontrolled glycemic control of A1c 9.7%(83 mmol/mol) despite using very high dose insulin therapy and metformin. Physical examination was unremarkable except for obesity. His A1c remained high despite increments in insulin dosage up to 350–400 units per day. A few months after adding dulaglutide to his regimen, the patient's HbA1c declined to ...