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30mg elemental iron

Between meals

Ferrous bisglycinate (gentle, well-absorbed) or iron protein succinylate

Prescription-only, clinician-titrated. Subcutaneous injection immediately before major meals. Type 1 diabetes: typically start 15 µg and titrate to 30-60 µg per meal. Type 2 diabetes (on mealtime insulin): typically start 60 µg and titrate to 120 µg per meal. Reduce mealtime insulin (often by ~50%) when starting. DO NOT self-dose.

With meals · with food

Subcutaneous pre-meal injection (Symlin / SymlinPen)

• Hemochromatosis or iron overload
• Repeated blood transfusions
• Adequate iron stores (test first!)

• Thyroid medications (levothyroxine)
• Antacids, PPIs
• Antibiotics (fluoroquinolones, tetracyclines)

• Confirmed diagnosis of gastroparesis (slowed gastric emptying would be worsened)
• Hypoglycemia unawareness
• Poor compliance with current insulin regimen or self-monitoring of blood glucose

• Insulin (mealtime / prandial)
• Other glucose-lowering agents (sulfonylureas, etc.)
• Oral medications requiring rapid absorption