Normalization of fasting hyperglycemia is beneficial for successful introduction of small amount of the GLP-1 analog liraglutide in an obese patient with type 2 diabetes mellitus

A 50-year-old diabetic woman was treated with intensive insulin therapy, but her glycemic levels were very high. After fasting hyperglycemia was normalized by intensive insulin therapy (34 U/day) and administration of 1000 mg metformin and 150 mg miglitol. We introduced liraglutide, a GLP-1 analog, and 0. 5 mg glimepiride on day 10. Liraglutide was dosed up to 0. 9 mg every 3 days. Metabolic data (fasting glucose, M values, plasma C-peptide, proinsulin/plasma C-peptide immunoreactivity ratio, obesity, and plasma leptin) improved after liraglutide administration. Interestingly, subcutaneous injection of only 0. 3 mg liraglutide for 3 days augmented glucose-stimulated insulin secretion and the proinsulin-to-CPR ratio, and inhibited plasma leptin concentration. Normalization of fasting hyperglycemia was beneficial for successfully introducing liraglutide in an obese patient with type 2 diabetes mellitus.