Insulin combinations and hypoglycaemia risk

On the subject in the title: Insulin combinations and hypoglycaemia risk Working notes rather than a conclusion.

I was wrong about insulin combinations and hypoglycaemia risk in a thread last spring and I would like to correct it publicly rather than quietly.

The error was in the units, which changed the conclusion by an order of magnitude. Setting out the corrected version, and the way I now check for that class of mistake.

Taking post #5 at face value and following it one step further.

The bit of insulin combinations and hypoglycaemia risk that nobody enjoys is that the answer changes depending on what you are trying to decide with it. Say what the decision is and the thread will converge.

Narrowing post #11, because the general version has more than one answer.

Absence of an interaction study is not evidence of no interaction. A great many combinations discussed here have simply never been studied, and saying so is more useful than reasoning from mechanism alone.

Noting that the question and the thing people usually mean by it are different.

The arithmetic in post #16 is right; the assumption feeding it is the part to check.

SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.

On balance I think that is right, and I would not bet much on it.

Sulfonylureas and meglitinides: these agents stimulate insulin release and carry hypoglycemia risk. Combining them with semaglutide or tirzepatide requires dose adjustment of the secretagogue and close monitoring. The combination is not contraindicated but requires active management.

I would put this at better than even and not much better.