Everyone is trying to get their hands on the fancy new weight loss drugs – which happen to be medications designed for people with diabetes. More specifically, they were originally designed for people with non-insulin dependent diabetes. However, there are some definite benefits for those of us who are insulin dependent as well. Here’s what you need to know about GLP-1 Agonists.
G-L-What?
GLP stands for Glucagon Like Peptide – meaning it’s a building block of protein similar to glucagon. Agonist is a medical word for helping something work as it should. So, basically, it’s a medication that helps a building block of proteins that is like glucagon work as it should in the body. Fun fact – this hormone was discovered in the venom of a Gila Monster, which is a lizard that lives in the southwestern U.S. and Mexico.1
Ok, great, but what does that mean?
In a person’s body without diabetes, glucagon and insulin work harmoniously to keep blood glucose levels in a normal range and help keep the body working as it was intended. But when you have diabetes, this relationship is disrupted along with other hormonal relationships. Thanks, diabetes.
There is another hormone that has been studied recently that works in tandem with GLP1 called GIP (glucose-dependent insulinotropic polypeptide). Because we needed more acronyms in diabetes…The two hormones – GLP1 and GIP – work together to increase the body’s insulin when you eat as well as help regulate feelings of fullness. These are still being studied because we don’t know all the answers yet about how they work, and if there are other hormones that also work with them.2
All of these are taken by injection once a week, except for Rybelsus, which is taken in a pill form daily.
Side Effects
Since the GLP1 medication slows down digestion, it can cause a few side effects that can be challenging.
Here are the most common:2,3
- Nausea
- Vomiting
- Diarrhea
- Low blood sugars
One of the other main side effects is typically part of the intended use for the medication – weight loss. This was not the original purpose of these medications but a side effect that many have used for this benefit. Additionally, these medications have been proven to reduce the risk of cardiovascular disease, heart attack, and stroke.3
Minimizing Side Effects
The good news about the side effects is that many of these meds come in doses that can be slowly increased over time. This helps reduce the side effects and can help when trying to adjust insulin doses. Since they can make you more sensitive to insulin over time, adjusting with each increase in dose may be necessary. The best way to avoid difficulties with potential low blood sugars is to start out reducing insulin doses when starting these drugs – especially mealtime doses.
Challenges with T1D or Insulin-Dependent Diabetes
Most people are prescribed a GLP1 agonist for treating type 2 diabetes. However, there are ongoing studies looking at how to use these medications effectively with type 1 diabetes or other insulin-dependent diabetes types. The studies that have been conducted have shown that people with T1D who are overweight or obese have the most benefits from the GP1 agonist category of medications.4
Since people with T1D take synthetic insulin, the body does not balance low blood sugars with glucagon as it does for people without diabetes. This means when the GLP1 medications start to work, blood sugars tend to drop. The best way to avoid difficulties with potential low blood sugars is to start out lowering insulin doses when starting these drugs. As mentioned, mealtime is usually the first adjustment, but over time you may also need to lower basal rates.
Another issue I experienced when trying various GLP-1’s was difficulty getting my blood sugar to come back up when low. Since digestion is slowed, I tried to use things like fruit snacks or skittles to get some absorption in my cheeks. Having glucagon is also super important, and I have definitely used some mini-doses in these experiences.
The Biggest Challenge
Of course, the biggest challenge with these medications in the U.S. is (you guessed it) coverage and cost. Celebrities have been using newer versions of the GLP1s and singing their praises which has caused shortages across the globe. The hard truth is that there are many people paying cash price for the drugs when those prescribed it cannot afford the co-pay. I recently had one prescribed, and the out of pocket WITH my private insurance was going to be $1200!! I couldn’t believe it. I tried to use the manufacturers’ coupon, but that only lowered it to $925. In the end, it didn’t matter anyway because they were completely sold out of the med.
Some insurances won’t cover the drug for people with type 1 diabetes, necessitating the use of prior authorizations, letters of medical necessity, and creative diagnostic codes.3 This can be difficult for many adults living with diabetes, especially if they see primary care providers, not endocrinologists, who may not be as comfortable or savvy in obtaining coverage.
In Summary
Like everything in diabetes, there is not a one-size-fits-all approach. Some people have great experiences with these drugs and find they work well for them. Others may struggle with the side effects and decide they are not worth it. At the end of the day, if you feel like you’re struggling with managing your weight while having diabetes, it’s worth asking your healthcare team if they would be willing to prescribe one of these meds and see how it goes.
- The therapeutic potential of a venomous lizard: the use of glucagon-like peptide-1 analogues in the critically ill
- The Emerging Role of Dual GLP-1 and GIP Receptor Agonists in Glycemic Management and Cardiovascular Risk Reduction
- Using GLP-1 Medications in Type 1 Diabetes
- Glucose-Lowering Therapy beyond Insulin in Type 1 Diabetes: A Narrative Review on Existing Evidence from Randomized Controlled Trials and Clinical Perspective
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
