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The keto diet has taken the health and wellness world by storm in recent years. With its focus on low-carb, high-fat foods, the keto diet has helped people lose weight, improve their energy levels, and even manage certain health conditions. However, sticking to a keto diet can be challenging, especially when you’re on the go or don’t have time to cook elaborate meals. That’s where Keto Luxe Brands come in. These luxury brands offer a range of keto-friendly products that make it easy to stick to your keto goals while enjoying delicious and convenient foods.

Indulge in Decadent Keto Treats

One of the most exciting aspects of Keto Luxe Brands is their selection of decadent keto treats. From keto-friendly chocolate truffles to low-carb cookies, these brands offer a variety of sweet treats that will satisfy your cravings without derailing your diet. Made with high-quality ingredients and free from refined sugars and grains, these treats are the perfect way to indulge in something sweet while staying true to your keto lifestyle.

For those looking for a quick and easy snack, keto-friendly protein bars are a great option. These bars are packed with protein and healthy fats, making them a convenient and nutritious choice for when you’re on the go. Plus, with flavors like chocolate chip cookie dough and peanut butter cup, you won’t feel like you’re missing out on anything.

Another popular option from Keto Luxe Brands is their selection of keto baking mixes. Whether you’re in the mood for pancakes, muffins, or bread, these mixes make it easy to whip up a delicious keto-friendly treat in no time. Just add a few ingredients, follow the instructions, and enjoy a homemade keto creation that tastes like it came from a gourmet bakery.

Elevate Your Keto Meals with Gourmet Ingredients

When it comes to cooking keto meals at home, using high-quality ingredients is key. Keto Luxe Brands offer a range of gourmet ingredients that will take your keto meals to the next level. From organic grass-fed meats to artisanal cheeses, these brands source the best ingredients to ensure that your meals are not only delicious but also nutritious.

If you’re looking to add some variety to your keto meals, consider trying out some keto-friendly sauces and condiments. From creamy alfredo sauce to tangy barbecue sauce, these products will add flavor and excitement to your meals without adding unnecessary carbs. With Keto Luxe Brands, you can enjoy restaurant-quality meals in the comfort of your own home.

For those who love to snack, Keto Luxe Brands offer a range of gourmet snacks that are perfect for munching on between meals. From crispy cheese crisps to savory nut mixes, these snacks are satisfying and delicious, making it easy to stick to your keto goals while enjoying tasty treats.

Stay Hydrated with Keto-Friendly Beverages

In addition to food products, Keto Luxe Brands also offer a selection of keto-friendly beverages to help you stay hydrated and refreshed. From sugar-free energy drinks to sparkling water infused with natural flavors, these beverages are a great way to quench your thirst without consuming extra carbs. Plus, with options that are caffeine-free and made with natural ingredients, you can feel good about what you’re drinking.

If you’re a coffee lover, you’ll be thrilled to know that Keto Luxe Brands also offer a variety of keto-friendly coffee products. From ground coffee blends to instant coffee packets, these products are specially formulated to be low in carbs while still delivering a rich and flavorful coffee experience. Whether you prefer a classic black coffee or a creamy latte, there’s a keto-friendly coffee option for you.

For those looking for a refreshing and energizing drink, Keto Luxe Brands also offer keto-friendly tea options. Whether you prefer green tea, herbal tea, or black tea, these products are sugar-free and make a great addition to your keto meal plan. Enjoy a hot cup of tea in the morning or sip on iced tea throughout the day to stay hydrated and satisfied.

Keto Luxe Brands offer a wide range of products that will enhance your keto experience and make sticking to your diet easier and more enjoyable. Whether you’re looking for sweet treats, gourmet ingredients, or refreshing beverages, these luxury brands have you covered. With high-quality ingredients, delicious flavors, and convenient options, Keto Luxe Brands are the perfect way to luxe up your keto lifestyle.

Benefits of Keto Luxe Brands

1. Convenience: Keto Luxe Brands offer a range of convenient products that make it easy to stick to your keto diet, even when you’re on the go.

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2. Quality: With high-quality ingredients and gourmet flavors, Keto Luxe Brands elevate your keto meals and treats to a whole new level.

3. Variety: From sweet treats to savory snacks to refreshing beverages, Keto Luxe Brands offer a wide range of products to suit every keto craving.

Overall, Keto Luxe Brands are a great way to elevate your keto experience and make sticking to your diet more enjoyable. Whether you’re looking for indulgent treats, gourmet ingredients, or refreshing beverages, these luxury brands have something for everyone. Explore the world of Keto Luxe Brands and discover how they can enhance your keto journey.

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You can actually gain SLABS of rock-solid muscle, eat like a KING, and finish with abs even more defined in just 21 short days: http://go.vincedelmontefitness.com/go/3202/YT-05-28-2013-DES1

What is the best way to lose fat without losing muscle? Find out in this episode of ATSGS!

Follow these rules if you don’t want to lose fat fast and maintain your muscle mass:

Best way to lose fat rule 1: Don’t go to extremes. On most cases it’s very hard to lose muscle when dieting, but when you go from no cardio to 7 cardio sessions per week, and 5000 calories to 1000 calories…expect to lose muscle.

Best way to lose fat rule 2: Don’t do excess cardio. Endless hours of slow go cardio has been shown to increase cortisol. Which when in excess levels causes fat storage and muscle loss. Do all-out sprints for the fastest fat loss.

Best way to lose fat rule 3: BCAAs are a good idea if your goal it to prevent muscle loss while doing an intense cutting cycle.

Best way to lose fat rule 4: Try to keep you workouts between 45-75 minutes. Working out for 3-4 hours in the gym at one time is overkill.

Watch the rest of the video for more tips on the best way to lose fat without losing muscle!

@0:12 – What is the best way to lose fat without losing muscle?

LIKE this video if you learned the best way to lose fat without losing muscle!

Thanks for watching. Train Hard.

Vince DelMonte
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Precision Nutrition Certified
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Have a friend that wants to know the best way to lose fat? Here’s the link to share:

PS:

Imagine for a moment, that it’s 21 days from today and you’ve already added 2 inches to your chest, an inch to your arms, broader shoulders and up to 12 pounds of rock-solid muscle to your frame.

Guys are asking you “what you’re on” and girls are giving you… that look.

There is one problem we must address right now…

CONTINUE READING HERE: http://go.vincedelmontefitness.com/go/3202/YT-05-28-2013-DES2

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I documented the first 2 weeks of my cut so you could see every single thing I shoved in my mouth!
I’m late to posting (of course) but over the next few weeks I’m going to show you what I’m eating and doing to lose the 5ish kgs I gained intentionally bulking.

I started at 66.1kgs on April 9th.

Time to reveal some of the muscle I built over the last 8 months!!

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Take control of your kidney health with these powerful superfoods! 🍎🥦 In this video, we explore the best foods to support your kidneys, reduce inflammation, and promote overall well-being. Whether you’re looking to maintain healthy kidney function or manage existing conditions, these nutrient-packed options can make a big difference.

💡 What you’ll learn:
✔️ Top superfoods for kidney health
✔️ How these foods benefit your kidneys

Stay tuned for easy, actionable advice and start your journey to better kidney health today! Don’t forget to like, share, and subscribe for more health tips and wellness advice.

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Pediatric and adolescent mental health challenges, including anxiety, depression, and ADHD, are reaching alarming levels and affecting millions worldwide. While the causes are still being explored, one potential contributing factor is the rising metabolic health epidemic, fueled by a harmful food environment.

With current treatment options often coming with challenging side effects and failing to provide lasting relief, many families are turning to innovative, evidence-based solutions to support their children’s well-being and long-term development.

In this interview, Dr. Lori Calabrese, a board-certified psychiatrist, shares her pioneering work in youth mental health care and discusses her experiences implementing ketogenic therapies in children and young adults.

In this interview, you’ll learn:
– What’s the difference between ketogenic therapy for adults vs. children?
– How to introduce ketogenic therapy to children and young adults
– The importance of having families on board with ketogenic therapy
– How to help children and young adults adhere to ketogenic therapies

Everyone deserves access to better mental health care, especially the young minds that hold the future to our society.

*Expert Featured:*
Dr. Lori Calabrese
X: @loricalabresemd
https://www.loricalabresemd.com/

Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry.

Learn more about metabolic psychiatry and find helpful resources at https://metabolicmind.org/

*About us:*
Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them.

Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications.

*Timestamps:*
0:00 – Is a Ketogenic Diet Effective For Youth Mental Illness?
1:12 – Using Ketogenic Therapies in Adults vs. Adolescents
3:25 – How to Introduce Ketogenic Therapies to Kids and Young Adults
5:10 – Is Ketogenic Therapy as Effective in Adolescents as Adults?
6:28 – Which Mental Conditions Can Ketogenic Therapy Help With?
8:44 – The Importance of Dietitian Support
10:22 – Can Kids Stick With a Ketogenic Diet?
13:11 – How Much Resistance Do Clinicians Have to Kids Using Ketogenic Therapy?

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Should You Cut Out Carbs To Lose Body Fat

You don’t have to completely cut out carbs, though it would be ideal

Focus on portion control. Meaning 6-9 oz of a protein source, about 2 cups of veggies, and 1/2 – 1 cup of a carb such as rice/pasta

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Are you looking for a delicious and convenient way to incorporate more healthy fats into your diet while following a ketogenic lifestyle? Look no further than Apple Keto Gummies! These tasty treats are perfect for satisfying your sweet cravings without derailing your nutritional goals. In this article, we will explore where you can buy Apple Keto Gummies at Priceline and why they are becoming a popular choice among keto enthusiasts.

Where to Buy Apple Keto Gummies at Priceline

If you’re eager to get your hands on Apple Keto Gummies, you’ll be pleased to know that you can find them at Priceline. Priceline is a well-known retailer that offers a wide range of health and wellness products, making it a convenient one-stop shop for all your keto needs. You can purchase Apple Keto Gummies both in-store and online at Priceline, so you can choose the shopping method that suits you best.

When browsing for Apple Keto Gummies at Priceline, be sure to check the product label to ensure that you are getting the right version for your dietary preferences. There are various flavors and formulations available, so you can select the one that aligns with your taste preferences and nutritional requirements. Additionally, keep an eye out for any promotions or discounts that Priceline may be offering on Apple Keto Gummies to make your purchase even more budget-friendly.

Benefits of Apple Keto Gummies

Apple Keto Gummies are not only delicious but also offer a variety of benefits that make them a valuable addition to your ketogenic diet. These gummies are typically made with high-quality ingredients that are low in carbs and sugar, making them a suitable choice for those following a keto lifestyle. They are also rich in healthy fats, such as MCT oil, which can help support your energy levels and promote satiety.

Another benefit of Apple Keto Gummies is their convenience. Whether you’re on the go or simply craving a sweet treat, these gummies are easy to carry with you and enjoy whenever you need a quick snack. They can satisfy your sweet tooth without causing a spike in your blood sugar levels, making them a guilt-free indulgence for keto followers.

How to Incorporate Apple Keto Gummies into Your Diet

There are numerous ways to incorporate Apple Keto Gummies into your daily routine to enhance your ketogenic experience. You can enjoy these gummies as a standalone snack between meals or pair them with other keto-friendly foods for a balanced and satisfying treat. Some people even use Apple Keto Gummies as a pre-workout snack to fuel their workouts and support their fitness goals.

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If you’re feeling creative, you can also use Apple Keto Gummies in recipes to add a touch of sweetness and flavor. From topping off your favorite keto desserts to mixing them into smoothies or yogurt bowls, the possibilities are endless. Experiment with different ways to enjoy Apple Keto Gummies and discover new ways to indulge in these tasty treats while staying true to your keto principles.

Final Thoughts on Apple Keto Gummies

In conclusion, Apple Keto Gummies are a delicious and convenient option for individuals following a ketogenic diet. With their tasty flavor and numerous benefits, these gummies can serve as a satisfying snack or treat to help you stay on track with your nutritional goals. Whether you purchase them in-store or online at Priceline, you can enjoy the convenience and quality of Apple Keto Gummies while supporting your keto lifestyle.

Give Apple Keto Gummies a try and discover a new way to enjoy sweet treats without compromising your health and wellness. With their low carb content and high-fat profile, these gummies are a perfect choice for anyone looking to add more flavor and fun to their keto journey. Make them a part of your daily routine and indulge in the deliciousness of Apple Keto Gummies today!

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* Over 60% of American are obese- thanks to junk food
* Comes the diet pills with catchy promises — but do they work?
* Diet pills come in three categories

* OTC’s or Over the Counter
* Herbal supplements
* Prescription pills
* Common side effects include uncomfortable cramping, gas and diarrhea

* WARNING: The DIET Industry is lying to you…

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* 97% of all Diets are doomed to failure.

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🔥 Drop “GLP1” in the comments AND HIT FOLLOW, and I’ll send you the link to my provider PLUS a code to save you money when you subscribe! Or go to the link in my bio to get approved in 60 seconds or less and use code LORRAINE25 for $25 OFF at checkout! Struggling to Lose Weight? You’re Not Alone. 😞 If you’ve tried everything—counting calories, cutting carbs, endless workouts—but the scale won’t budge, I get it. It’s exhausting. For so long, I thought I just needed more willpower, but the truth is—weight loss isn’t just about eating less and moving more. Your hormones, metabolism, and even hunger signals all play a role. That’s why GLP-1 medication has been a game-changer. It helps regulate appetite, balance blood sugar, and make weight loss feel possible instead of an uphill battle. If you’re feeling stuck, just know there’s another way. You don’t have to keep struggling. Have you been in this cycle? Let’s talk in the comments! ⬇️ #GLP1 #WeightLossStruggles #GLP1Community #GLP1Medication #GLP1ForWeightLoss

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Here is the best chicken soup recipe for quick weight loss. It is oil free and perfect for high protein low carb diet or soup diet. Lose weight fast with this ultimate homemade oil-free chicken soup recipe.
Ingredients:
Chicken with bones- 200-250 gms
Red onion- 1 cup (sliced)
Garlic- 4-5 cloves
Ginger- 1/2 inch
Light Soy Sauce- 1 tsp
Green onions- 1-2 stalks
Celery- 1 stalk
Sweet Corn Kernel- 1/2 cup
Salt and pepper to Taste

Procedure: Marinate the chicken with just some lemon juice and salt for about 30-40 minutes. Wrap it with a cling wrap and put it in the refridgerator for about 30 mins. After 30 mins, take
the chicken out and place it in a pressure cooker. Throw in 1 cup of sliced red onions, 4-5 cloves of crushed garlic, half a inch ginger thinly sliced. Add in some salt and some freshly
cracked black pepper, add in 1 teaspoon of light soy sauce. Lastly pour 3 cups of water and give it a quick stir. Cover the lid and place the pressure cooker on high flame.
After the 1st whistle, lower the flame and let the chicken cook on low heat for another 8-10 minutes. After 10 minutes, switch off the gas and open the lid once all the steam has released.
Take out only the chicken pieces in another container and let them cool down. In the meanwhile, finely chop some green onions or spring onions and a small stalk of celery. Once the chicken pieces are cool enough to touch, start shredding the flesh, Now switch on the gas again and add the shredded pieces back into the broth. Also add the celery and the sweet corn kernels. Give it a good mix and let it come to a boil. Take 2 tsp of cornflour and add in a little
water to it to make a smooth paste. Now add in this cornflour paste to your broth and give it a good stir. Next in a separate bowl, lightly beat 2 egg whites and pour it into the soup. Stir quickly in circular motions as soon as pour the egg white in. Let it come to a boil. Finaly, add the sping onions. Just keep some aside for garnish. check for seasoning. Add more salt or pepper as per your taste and that is it . Your delicious restaurant quality chicken soup is ready.

If you are a vegetarian, check out my oil free vegetable soup recipe for weight loss.

Oil- free vegetable soup: https://www.youtube.com/watch?v=4mo9gwj38Cg

Please subscribe to TheHungryGypsy for more simple and interesting recipes, weight loss tips and diet plans.
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This video will explain how metformin is useful for weight loss, especially in PCOS cases. But this drug needs proper prescription guidance for diabetes, bodybuilding, and for weight loss. Because self-medication can harm you.
•Take this medication by mouth as directed by a doctor, usually 1-3 times a day with meals.
•Drink plenty of fluids while taking this medication
Side effects of metformin
•Nausea, vomiting, stomach upset, diarrhea,
•weakness, or a metallic taste in the mouth may occur.
•Stomach symptoms that occur after the first days of your treatment may be signs of lactic acidosis.
•Metformin does not usually cause low blood sugar (hypoglycemia). if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
Keep a list of all the products you use Do not start, stop, or change the dosage of any medicines without your doctor approval.Beta-blocker medications (such as metoprolol, propranolol, glaucoma eye drops such as timolol) may prevent the the symptoms of hypoglycemia.
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Disclaimer: This video is for educational and general informational purposes only and it helps in the general understanding of various health issues. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between us and you. You should not make any change in your treatment, health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Shaun Tips is not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this video or site. This video is not for sale.
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Please contact me For any matter and sponsorship purpose or video deleted
: — bipeenku50@gmail.com

Video Credit 🎥 : — I respect the real owner of the video
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Disclaimer: This information is taken from the internet which may or may not be true we DO NOT want to spread any fake news. The content provided by this channel is meant for EDUCATIONAL PURPOSE only.

Copyright Disclaimer:- Under section 107 of copyright Act 1976, allowance is made for FAIR USE for purpose such a criticism, comment, news reporting, teaching, scholarship and research. Fair use is as permitted by copyright statues that might otherwise be infringing. Non-profit, educational or personal use tips the balance in favor of fair use.

All materials in these videos are used under fair use guidelines. No copyright infringement is intended. If you are or represent the copyright owner of the materials used in this video and have a problem with the use of said material, please contact the email below. I will make the video private or remove it immediate

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Keto Luxe, a revolutionary weight loss product, made its highly anticipated debut on the hit television show Shark Tank, leaving audiences amazed and intrigued. In the episode, Keto Luxe founders showcased their innovative weight loss formula that promises to help users shed unwanted pounds quickly and effectively. The panel of investors on the show were impressed by the product’s unique approach to weight loss and its potential to revolutionize the industry. With its Shark Tank debut, Keto Luxe has become a game-changer in the world of weight loss supplements.

The Science Behind Keto Luxe

Keto Luxe utilizes the power of the ketogenic diet to help users achieve their weight loss goals. The ketogenic diet is a high-fat, low-carbohydrate eating plan that forces the body to burn fat for fuel instead of glucose. By following a ketogenic diet, the body enters a state of ketosis, where it produces ketones that help burn fat more efficiently. Keto Luxe enhances the effects of the ketogenic diet by providing users with a proprietary blend of ingredients that promote fat burning, suppress appetite, and increase energy levels.

One of the key ingredients in Keto Luxe is beta-hydroxybutyrate (BHB), a type of ketone that the body produces during ketosis. BHB helps the body transition into ketosis more quickly, making the weight loss process faster and more effective. In addition to BHB, Keto Luxe also contains powerful antioxidants and vitamins that support overall health and well-being. The combination of these ingredients makes Keto Luxe a potent weight loss supplement that can help users achieve their weight loss goals.

The Benefits of Using Keto Luxe

There are numerous benefits to using Keto Luxe as part of a weight loss regimen. One of the primary benefits is its ability to promote fat burning and weight loss. By helping the body enter ketosis more quickly and efficiently, Keto Luxe accelerates the fat burning process, allowing users to see results faster. Additionally, Keto Luxe helps suppress appetite, making it easier for users to stick to their diet and avoid overeating. This can lead to greater weight loss success and improved overall health.

Another benefit of using Keto Luxe is its ability to increase energy levels. Many users report feeling more energized and focused while taking Keto Luxe, which can help improve performance in both daily activities and workouts. By providing a steady source of energy without the crashes associated with sugary snacks and drinks, Keto Luxe helps users stay motivated and on track with their weight loss goals.

Real People, Real Results

Since its Shark Tank debut, Keto Luxe has gained a loyal following of satisfied customers who have seen real results from using the product. Many users report losing significant amounts of weight in a short period of time, with some seeing results in as little as a few weeks. Users also praise Keto Luxe for its ease of use and convenience, making it a simple addition to their daily routine.

One user, Jessica, shared her Keto Luxe success story, saying, “I struggled with my weight for years and tried countless diets and supplements with little success. But since starting Keto Luxe, I’ve lost over 20 pounds and feel better than ever. It’s truly changed my life.” With testimonials like Jessica’s, it’s clear that Keto Luxe is making a positive impact on the lives of its users and revolutionizing the weight loss industry.

Final Thoughts

Overall, Keto Luxe’s Shark Tank debut has solidified its position as a game changer in the world of weight loss supplements. With its innovative approach to weight loss, powerful ingredients, and real results from satisfied customers, Keto Luxe is poised to become a leader in the industry. Whether you’re looking to lose a few pounds or make a significant lifestyle change, Keto Luxe offers a safe, effective, and convenient solution to help you achieve your weight loss goals. Try Keto Luxe today and experience the difference for yourself!

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What I eat in a day losing weight
22kgs down so far…

Biscoff & banana breakfast protein cookie
Coffee x2
Honey soy chicken rice bowl
Peanut butter rice crispy bites
Iced coffee protein bar
Protein pizza & caesar salad
Mochi ball

Calories: 1671
Protein: 112g

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Keto Acv Max What You Need To Know

Over the years, the ketogenic diet has gained popularity for its numerous health benefits, including weight loss, improved mental clarity, and increased energy levels. Many people are looking for ways to enhance their keto journey, and one product that has been making waves is Keto BHB. This revolutionary supplement has been featured on Shark Tank and is now available for purchase on Amazon. In this article, we will take a closer look at Keto BHB’s Shark Tank Amazon breakthrough and explore what makes this product so special.

The Science Behind Keto BHB

Keto BHB is a supplement that contains exogenous ketones, which are ketones that are not naturally produced by the body but can be consumed to help the body enter a state of ketosis more quickly. Ketosis is a metabolic state where the body burns fat for fuel instead of carbohydrates, leading to weight loss and other health benefits. By taking Keto BHB, you can speed up the process of reaching ketosis and experience the benefits of the ketogenic diet sooner.

One of the key ingredients in Keto BHB is beta-hydroxybutyrate (BHB), which is a type of exogenous ketone that has been shown to increase energy levels, improve mental focus, and aid in weight loss. When you take Keto BHB, the BHB is absorbed into your bloodstream and can cross the blood-brain barrier, providing your brain with a direct source of energy. This can help enhance cognitive function and clarity, making it easier to stay focused and productive.

In addition to BHB, Keto BHB also contains other natural ingredients that can support your keto journey. These ingredients may help reduce cravings, boost metabolism, and support overall wellness. By taking Keto BHB regularly, you can optimize your ketogenic diet and achieve your health and weight loss goals more effectively.

Benefits of Using Keto BHB

There are several benefits to using Keto BHB as part of your ketogenic diet regimen. One of the main advantages is that it can help you reach ketosis faster, which can lead to quicker weight loss results. By taking Keto BHB, you can kickstart your body’s fat-burning process and start seeing the scale move in the right direction.

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On March 1, more than 170 people lined up for the chance to appear on the popular ABC show “Extreme Weight Loss.” The Bariatrics Center at Nebraska Medicine was a sponsor for the event.

Auditions were held at Mrs. B’s Clearance & Factory Outlet Center located next to Nebraska Furniture Mart. Despite the cold weather, the line started to form at 3:30 a.m.

To qualify for the audition, candidates need to lose half their body weight. Once a contestant is chosen, they will have 365 days to lose the weight with the help of celebrity personal trainer Chris Powell.

The fifth season of “Extreme Weight Loss” is expected to begin filming in May.

For more information on the Bariatrics Center at The Nebraska Medical Center, visit their website: http://www.nebraskamed.com/bariatricscenter/

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GLP-1 agonists are not only for weight loss but also for patients with diabetes. Anne Peters, MD, discusses the importance of monitoring dosing between insulin and GLP-1 agonists.
https://www.medscape.com/viewarticle/997976?src=soc_yt

— TRANSCRIPT —
We’ve all been hearing about the weight loss benefits of glucagon-like peptide 1 (GLP-1) receptor agonists, but it’s important to remember that they are also diabetes medications. If you have a patient who’s on an insulin secretagogue and/or insulin, it’s important to remember that you need to adjust those medications to avoid hypoglycemia as you start and uptitrate the GLP-1 receptor agonist.

This isn’t really cookbook, in the sense that you have to think about each patient, but I’ll tell you what I do. 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_yt