Glucagon Like Peptide – 1 (GLP-1)

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Continuing with our medication series today we are discussing the class known as glucagon like peptide-1 (GLP-1). As with all the posts in this series, this is not advice about whether you should or should not take them. Only how they work and the pros and cons of each medication.

What is GLP-1?

GLP-1 is one of the hormone your body produces after eating known as incretins. GLP-1 helps to slow down the transit of food through your intestinal tract and helps to make you feel full up after eating. We call this satiety.

A GLP-1 medication is an injectable medication. The earlier types of GLP-1’s were daily injections because the half life of the medications was short. Over recent years, the medications have become more potent and last longer in your body. Therefore, newer preparations only need to be taken once a week.

These are mostly used in type 2 diabetes but there will be instances when they are used in type 1 diabetes.

Examples of these medications include:

  • Exenatide (Byetta/Bydureon)
  • Liraglutide (Victoza)
  • Lixisenatide ((Lixumia)
  • Dulaglutide (Trulicity)
  • Semaglutide (Ozempic)

Benefits of using GLP-1

GLP-1’s are quite effective in lowering your glucose levels. You can expect your HbA1c to drop by 1-2% (11-22mmol/mol) once starting this medication.

However, GLP-1 has several benefits extending beyond just blood glucose control. Due to the fact GLP-1 therapy slows the digestion and absorption of food it helps to lower glucose spikes after eating. GLP-1 therapy makes you feel full up and therefore reduces your appetite. This is why they are a good option for people needing to lose weight. In fact, the newer versions such as Semaglutide, can help people lose up to or even over 7kg in weight.

Some variations have data to show they help protect your cardiovascular health. Therefore, GLP-1 therapy may also be used if you have cardiovascular risk factors.

There is a low risk of hypoglycaemia with GLP-1. Therefore, starting GLP-1 therapy does not require you to test your glucose levels day to day.

Negatives & Side effects of using GLP-1s

The most common side effect of GLP-1 therapy is gastrointestinal discomfort and nausea. However, some health professionals will argue this demonstrates you are a responder to the medication and these symptoms should be short lived.

In severe cases, you may experience diarrhoea or vomiting. In this instance, it is likely you may need to reduce your dose or stop the medication completely.

When not to use GLP-1 therapy

Like most diabetes medications, caution needs to be practiced with renal impairment. The newer versions of these medications can be used into advanced renal disease but caution may still be needed.

If you suffer with pancreatic problems, have endocrine neoplasms and/or thyroid cancer your team may suggest stopping this medication.

There is also a small risk of developing gall stones/gall bladder inflammation and diabetic keto acidosis.

There’s also a small chance of worsening pre existing retinopathy with certain types of GLP-1 therapy.

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