Hypoglycemia: Monitor required insulin and/or insulin secretagogue dose.Gastrointestinal side effects: Initiating slow dose and up titrate as tolerated. Recommend dietary changes.Gallbladder disease: Evaluate if symptoms of cholelithiasis are of concern.Pancreatitis: Stop medication.Medullary thyroid cancer: Medication counter-indicated in patients with a history or family history of MTC.Retinopathy: Close follow-up in patients with moderate to severe retinopathy, particularly those who experience a rapid reduction of hemoglobin A1C levels with GLP-1 receptor agonist therapy. The gene discussed is INS; the disease is cholelithiasis.