DPP4 and Hypoglycemia: Notably, insulin secretagogues in combination with insulin may exacerbate weight gain and hypoglycemia, and there has been debate about whether these medications should be universally discontinued when insulin is started.[9–11] There is also little evidence as to whether newer diabetes medications, such as dipeptidyl peptidase 4 inhibitors (DPP4 inhibitors), glucagon-like peptide 1 receptor agonists (GLP1 receptor agonists) or sodium-glucose co-transporter inhibitors (SGLT2 inhibitors), should be continued after insulin is started.