Drug Facts: GLP-1 Receptor Agonists

Is it weird to say I have a favorite diabetes drug class? Well I do, and it is the GLP-1 receptor agonists! From my experience working with patients using them, they do a great job lowering blood sugars, they don't cause hypoglycemia (unless they're used with insulin or sulfonylureas), and they help with weight loss. Some of them also have cardiovascular benefits.

GLP-1s are injectable medications (with the exception of the newer oral semaglutide), but they are not insulin. Depending on what kind you’re using, you may take it once a week, once a day or twice a day. All of them are available in a pen and most are very easy to use. I see that many people shy away from these medications because they don't want to stick themselves with a needle. Just remember that the needle is very small and most people don't even feel it. If you can poke your finger to test your blood sugars, you can definitely do this!

These medications work by activating GLP-1 receptors which stimulate the secretion of insulin by the pancreas. They also decrease how much sugar the liver produces and slows down the digestion of food in your GI tract.

These drugs can assist with weight loss. This is due to its effect on digestion; GLP-1's can slow down the rate at which food passes through your stomach and can decrease appetite. GLP-1s are so good at helping with weight loss, both Trulicity (dulaglutide) and Victoza (liraglutide) are sold at higher doses as weight loss drugs, Wegovy and Saxenda. These products can be used by people that are overweight and obese whether or not they have diabetes.

After being around for a while, three of the drugs have also been FDA approved to have cardiovascular benefits. This is HUGE, as people with diabetes are at a much higher risk for heart disease, and cardiovascular disease is a top cause of death in people with diabetes. Victoza and Ozempic has been FDA approved to decrease the risk of major cardiovascular events (heart attack, stroke, cardiovascular death) in adults with type 2 diabetes that have cardiovascular disease. Trulicity has a similar FDA approval but also extends to people with type 2 diabetes that don’t have diagnosed cardiovascular disease but they have multiple risk factors for it. Again, this is very big news! Many SGLT2 inhibitors have also shown to have cardiovascular benefits (and other benefits as well).

Unlike some other medications for diabetes, GLP-1s work in a glucose-dependent fashion. This means that if blood sugars are high, the drug will work harder. Conversely, if blood sugars are low, the drug will work less. This is beneficial as they should not cause hypoglycemia.

These drugs take some time before you will see the full blood sugar lowering effect. The ones that are taken once or twice daily will start working faster. For the ones that are taken once a week, it may take two to seven weeks to see the full effect. You will probably also start on a low dose and titrate up to the dose you need to help minimize gastrointestinal side effects.