GLP-1 Receptor Agonists
“More and more clinicians are using GLP-1s off-label in people with type 1 diabetes, particularly in those who also have obesity or high insulin requirements,” says Mihail Zilbermint, MD, an associate professor of medicine at Johns Hopkins University School of Medicine and the chief of the division of endocrinology, diabetes, and metabolism at Suburban Hospital in Maryland.
The Benefits
Dr. Zilbermint says that GLP-1s can help lead to fairly meaningful weight loss, improve blood sugar modestly, and reduce an individual’s daily insulin needs:
- Weight Loss Improved insulin and blood sugar management techniques have allowed people with type 1 diabetes to live increasingly normal lifestyles, so the incidence of obesity has risen within the community. GLP-1 drugs help people with type 1 diabetes lose weight, which can make diabetes management easier.
- Decreased Insulin Needs GLP-1s help the body become more sensitive to insulin, which can lead to significantly lower insulin doses.
GLP-1 drugs also have a wide variety of positive long-term health effects, from lower blood pressure and cholesterol to improved kidney health, which may help guard against some of the most prominent and dangerous complications of type 1 diabetes.
The Risks
Gastrointestinal side effects like nausea, vomiting, and diarrhea are common among people with type 1 diabetes who take GLP-1 medications.
Another challenge with GLP-1 use in someone with type 1 diabetes is the potential risk of hypoglycemia, or low blood sugar. It’s the reason the FDA has been hesitant to approve GLP-1 use for people with type 1 diabetes, says Dace Trence, MD, the president of American Association of Clinical Endocrinology and a professor emeritus at the University of Washington in Seattle.
The risk may be especially elevated when you use GLP-1 drugs for the first time. If they supercharge your insulin sensitivity, and you don’t quickly adjust your doses to compensate, you could end up with a dangerously low blood sugar level. However, with the right adjustments and the close collaboration of your endocrinologist, your risk of hypoglycemia may not rise much at all.
GLP-1 drugs also have the potential to trigger the development of DKA. Preliminary research suggests that this side effect is not common, but DKA nevertheless remains a potential consequence of the dehydrating side effects like vomiting and diarrhea that GLP-1 drugs are known to cause.
Because of these risks, doctors may choose to prescribe very small doses of GLP-1s to people with type 1 diabetes, especially if they do not have a lot of weight to lose.
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