Morford JJ, Wu S, Mauvais-Jarvis F
This article examines the evidence, explores alternative causes of nose bleeds in people with diabetes, and provides guidance on when to seek medical advice
However, we recommend you return the pen to the fridge after each use
Other diabetes medication classes offer alternatives if GLP-1 therapy proves unsuitable: SGLT2 inhibitors (such as dapagliflozin or empagliflozin) provide cardiovascular and renal benefits without affecting gastric emptying, though require adequate renal function and carry risks of genital infections and diabetic ketoacidosis DPP-4 inhibitors (such as sitagliptin) work on the incretin system but with less pronounced gastrointestinal effects note these should not be combined with GLP-1 receptor agonists Traditional agents including metformin, sulfonylureas, or insulin may be appropriate depending on individual circumstances Any medication change should be made in consultation with your diabetes specialist or GP, considering your overall glycaemic control, cardiovascular risk profile, and treatment goals, in line with NICE NG28 guidance

Treatment with interferon-alpha (IFN alpha) of hepatitis C patients induces lower serum dipeptidyl peptidase IV activity, which is related to IFN alpha-induced depressive and anxiety symptoms and immune activation
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