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If semaglutide is combined with medicines that can cause low sugar, especially insulin or sulfonylureas If you skip meals, have prolonged fasting, heavy alcohol intake, vomiting, or severe illness If you have diabetes and you are on multiple glucose-lowering drugs, dose adjustments may be needed That is why doctors warn more about hypoglycemia when semaglutide is used along with insulin or sulfonylureas, not when it is used alone

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