GLP-1 agonists & diabetes
Some people with type 2 diabetes can manage their condition and reach their target blood glucose levels through healthy eating and being physically active, but most also need either insulin or other medications to help lower their blood glucose to their target levels.
The first medication doctors often prescribe to control blood glucose, along with healthy lifestyle habits, is metformin. But for some people metformin does not work well enough to lower their blood sugar, or they are not able to take it because of side effects or other reasons.
Among the categories of other glucose-lowering medications for type 2 diabetes are GLP-1 agonists, also known as glucagon-like peptide-1 receptor agonists, and these drugs differ in the way they are administered, including a daily oral tablet, a daily injection, or a weekly injection. Examples you may have heard of for diabetes management in Canada are semaglutide (Ozempic®, Rybelsus®), dulaglutide (Trulicity®), tirzepatide (Mounjaro®), or liraglutide (Victoza®). There are also GLP-1 agonist products available in Canada that are designed specifically for weight loss, including liraglutide (Saxenda®) and semaglutide (Wegovy®).
GLP-1 agonists generally work by increasing your body’s response to blood sugar in the foods you eat. They affect two hormones created in your pancreas. They increase insulin release (a hormone that helps lower blood glucose by moving it out of your blood stream and into your cells to be used for energy), and they decrease glucagon release (a hormone that raises blood sugar). These medications also slow the emptying of your stomach into your intestines, so you feel full longer, less glucose is released from the foods you eat, and your appetite is suppressed.
Drugs in this category have gained a lot of attention, because of their side effect of relatively fast weight loss. Some sources claim up to 20% body weight loss per year. But all medications have potential side effects. Read on to learn more.
WHO SHOULD TAKE GLP-1 AGONISTS?
The decision about which diabetes medications are best for you depends on a number of factors, including your blood glucose readings, your symptoms, and other health problems you may have.
While GLP-1 agonists are generally considered safe and effective, they are not right for everyone. Your doctor may recommend a GLP-1 agonist for you if:
- Metformin isn’t reducing your blood glucose level enough, or if it unsafe for you to use it.
- Your A1C level is higher than your target level.
- You haven’t reached your A1C goal (a measure of your three-month average blood sugar level)
and you have additional health conditions such as atherosclerosis (a buildup of fats, cholesterol, and other substances on your artery walls), heart failure, or kidney disease.
BENEFITS AND SIDE EFFECTS
Like all medications, GLP-1 agonists can have both benefits and side effects. In addition to helping you manage your blood glucose, they may:
- Help you lose weight, which can help you manage your blood glucose
- Reduce your risk of heart disease and kidney disease
- Lower your blood pressure
- Improve the levels of cholesterol and triglyceride in your blood
- Improve fatty liver disease
- Delay the progression of diabetes-related nephropathy (nerve damage)
When you begin the medication or your dose increases, the most common side effects are mild to moderate nausea, diarrhea, constipation, abdominal pain, or vomiting. Starting on a low dose and increasing slowly can help with this. Other side effects may include dizziness, headache, indigestion, and infections. Some rare, but serious, side effects are also possible, such as inflammation of your pancreas, vision changes, hypoglycemia (low blood sugar), kidney problems, gallbladder problems, possible thyroid tumours, or serious allergic reactions.
Taking other diabetes medications along with a GLP-1 agonist may raise your risk of hypoglycemia. It is important to understand that the weight loss effects are usually only sustained while taking the medication, and the weight can return when the medication is stopped.
While taking a GLP-1 agonist, you should see your healthcare provider regularly to assess how well the medication is working. You should also contact your provider if you:
- Develop bothersome symptoms
- Don’t think it is working to manage your diabetes
- Are thinking about stopping the medication
- Become pregnant or are thinking about getting pregnant
ARE GLP-1 AGONIST MEDICATIONS RIGHT FOR YOU?
Managing diabetes is not a one-size-fits-all plan. Treatment will vary from person to person depending on many factors. If you are considering a GLP-1 agonist medication, like Ozempic, you may want to discuss the following with your healthcare team:
- How close am I to reaching my A1c goal? Could a GLP-1 agonist help me meet that goal?
- How does a GLP-1 agonist differ from the medicines I am currently taking to manage my diabetes?
- What kind of benefits and side effects can I expect?
- What dosage form is right for me? Injection or tablets? Weekly or daily?
- Am I covered on a provincial or private insurance plan for this type of medication?
If you have any questions about managing your diabetes or about any of the medicines you take, your London Drugs pharmacists are available to guide you.
