-Gary Scheiner MS, CDE and Alicia Downs RN, MSN, CDE
It may seem tough for people with type 1 diabetes to fathom adding more injections to their blood sugar management routines, but they might consider it if it meant better blood sugar stability, with a little weight loss to boot. That additional injection that some people with type 1 diabetes are considering is a group of drugs called glucagon-like peptide-1 receptor agonists, or GLP-1s for short.
GLP-1 drugs have been on the market since 2005 for the treatment of type 2 diabetes. Brands include:
Some are taken twice daily, some once daily, and others once weekly.
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In the natural order of things, GLP-1 hormones are typically produced by the intestines when we eat. They stimulate pancreatic insulin production, slow gastric emptying (so we feel full sooner), enhance satiety (makes us less hungry), and reduce glucagon output from the pancreas. All these effects combine for flatter after-meal blood sugars and less food intake. Though these drugs are only currently approved by the FDA for type 2 diabetes, they could prove a benefit for people with type 1 diabetes, as well.
That’s because most people with type 1 diabetes still make a tiny bit of insulin on their own. Animal studies have even shown evidence that GLP-1 hormones help increase the number of beta cells (insulin-producing cells) in our pancreas, and may also slow the destruction of beta cells. This means that patients who are “honeymooning,” or still making some of their own insulin, could in theory see an increase in their own insulin production. Studies are still underway to validate this, however.
The chief downsides to GLP-1 use that have been observed are nausea and gastric upset. Clinicians have found that the key to minimizing stomach upset for many patients is to start at a low dose and raise it slowly until an effective dose is achieved.
Hypoglycemia is another potential concern with GLP-1s. The drugs block glucagon production by the pancreas in a round-the-clock fashion, so insulin doses may need to be reduced slightly. Also, the delayed gastric emptying induced by GLP-1s have the potential to cause low blood sugar after eating, so mealtime insulin doses may need to be delayed for some people. Finally, delayed gastric emptying may also cause a slight delay in blood sugar rise for treating hypoglycemia. With GLP-1s, you’re essentially introducing another factor into blood glucose management, so additional monitoring is important.
The studies conducted thus far have shown that GLP-1s are generally safe and effective for patients with type 1 diabetes. Nevertheless, they are not currently approved by the FDA for this population, so prescribing these drugs for type 1 diabetes is “off label”. May healthcare providers are comfortable (and comfortable with) prescribing medications “off label,” but not all. In most cases, with a little bit of added paperwork, a progressive prescriber even can get insurance to cover them.
This information, provided by two certified diabetes educators, should not be seen as an endorsement of this drug treatment. Please consult your healthcare provider about any blood sugar management decisions.
Gary Scheiner is Owner and Clinical Director of Integrated Diabetes Services, a private practice specializing in intensive insulin therapy for children and adults. Visit www.integrateddiabetes.com for more information. Alicia Downs RN, MSN, CDE is the Director of Patient Care and Education at Integrated Diabetes Services, specializing in managing diabetes with co-occurring diagnoses. Both have type 1 diabetes and use insulin pump & CGM technology, as well as non-insulin options for management.