[2026 update] Insulin combinations and hypoglycaemia risk

Insulin combinations and hypoglycaemia risk Writing it up because I had to work it out twice and would rather nobody else did.

Practical question with the units stated, because I have seen how quickly these go wrong without them.

I have a 2 mg vial of semaglutide and I am working to a 5.0 mg step. My syringes are U-100 insulin syringes, 1.0 mL barrel.

I can do the arithmetic and I have done it twice, getting the same answer both times, but I would like someone to check the reasoning rather than the number — specifically whether I have thought about the residual volume correctly, and whether the graduation I am landing on is one a person can actually read.

Insulin interaction: semaglutide and tirzepatide are not contraindicated with insulin but the combination carries hypoglycemia risk if insulin doses are not adjusted. That is a reason for close monitoring, not for avoiding the combination.

I read the opening post twice before replying, because I had assumed the opposite.

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.