GLP1 (Glucagon-like peptide-1) is a hormone that plays an important role in blood sugar control and appetite regulation. It promotes insulin secretion and inhibits glucagon release, which helps to lower blood sugar levels. It also delays emptying of the stomach and suppresses appetite, thus contributing to weight loss.
GLP-1 Receptor agonists enhance the effects of GLP-1 in the body. Currently, there are five medications approved by the FDA for weight loss. These include Ozempic, (semaglutide) which is an injection given weekly, Saxenda, (Liraglutide) which is an injection given daily, Rybelsus (semaglutide tablets) which are given daily, Mounjaro and Zepbound, (tirzepatide, which is a GLP-1/GIP agonist) are injections given weekly. GIP is another hormone produced by the body which stimulates insulin secretion after eating.
There are many benefits to the GLP-1 agonists. They help improve blood sugar control by stimulating insulin production in the pancreas, and they inhibit the release of glucagon, both which help regulate blood sugar levels, thus aiding in the treatment of type 2 diabetes.
Because GLP-1 affects appetite regulation, these medications often result in weight loss, which is a beneficial side effect for patients with type 2 diabetes who are often overweight or obese. They contribute to weight loss in several ways. They basically send a message to your brain telling the brain you are full, thus decreasing your appetite. It also slows down how fast your stomach empties, so you feel full longer.
GLP-1 agonists have been recently shown to reduce the risk of major cardiovascular events such as heart attack and stroke in people with type 2 diabetes.
GLP-1 agonists have a beta cell preserving effect, thus helping keep the pancreas healthy which is important for ongoing insulin production. Many older drugs for type 2 diabetes exhaust the pancreas, leading to loss of beta cells and total shut down of insulin production late in the life of type 2 diabetes.
Like most medications, GLP-1 agonists can potentially come with some side effects. These can vary between different medications and individuals. The more common side effects include nausea and vomiting, especially when you start taking the medication. This often gets better over time as your body adjusts to the medication. This is why the medications are usually started at a low dose and gradually titrated up to a dose that is most effective.
Some people may experience diarrhea, which can be a discomfort, but can generally be managed.
Since these medications work by making you feel fuller, some people can feel a significant decrease in their appetite.
Since many of these GLP-1 agonists are given by injection, there can sometimes be reactions at the injection site, like redness, itching or swelling.
Rare but serious side effects can also occur, such as pancreatitis (inflammation of the pancreas), changes in heart rate, kidney issues, or allergic reactions. It is important that any side effects are managed appropriately, and if you experience any distressing or persistent side effects, contact your healthcare provider. They can provide advice on managing side effects and can decide whether the medication is right for you. Remember, all medications have potential benefits and risks: the key is to find the balance where the benefits outweigh potential side effects.
When I prescribe a GLP-1 agonist, I always refer my patients to a dietician. These medications are not magic and will not work if you do not follow very specific dietary instructions. In addition to taking these medications, you need to be eating a healthy diet. It will not work well at all if you continue to eat foods that got you in the weight problem that you are in. Load up on lean protein, fruits and vegetables. Just as in any weight loss program you need to limit processed foods, sugary foods and calorie dense foods. A dietician can help you in this regard. Also, you need to follow your body’s cues. If you are not hungry, DO NOT EAT! I have had several people on these medications tell me I really wasn’t hungry but it was lunch time (supper time, snack time) so I ate anyway. One of the mechanisms of action of these drugs is to decrease your appetite, so take that cue.
As you lose weight, exercise also becomes a major part of the program. Taking in less calories is one thing, if you burn up more by increasing your daily activities and exercising, you can double your efforts. For a more complete discussion on exercise, please see other articles I have written on exercise, or check out my You Tube channel docmiketheexercisedoc.
When patients take the medication, follow a healthy diet, take their body’s cues, and exercise, I have had patients lose up to and over 20% of their body weight.
These medications are VERY expensive and cost on average about $1000 monthly (please don’t start me railing against the pharmaceutical companies). Medicare will only approve them for people with diabetes, not for treatment of obesity. Other insurance companies have their own rules and regulations for approving them. Since they are becoming more popular and useful in the treatment of type 2 diabetes as well as obesity, there is a shortage of them. As a matter of fact, my office got a notice from Novo Nordisc and the FDA reporting that there is a severe shortage of Saxenda and Zepbound that may last through 2024.
In conclusion, GLP-1 receptor agonists are very useful drugs for the treatment of type 2 diabetes as well as obesity. They are expensive, there are shortages of them nationwide, but, if used with a healthy diet, exercise and following your body’s cues, work very well.