Fig. 5

The detailed mechanism of pasireotide-induced hyperglycemia and its optimal management in relation to pathophysiology. Drastic inhibition of GLP-1 secretion through shutdown of the main pathway is the primary cause of pasireotide-induced hyperglycemia. GLP-1 analogs, rather than DPP-4 inhibitors, spare pasireotide-induced depletion of endogenous GLP-1 and restore insulin secretion.