These injectable drugs are usually prescribed along with oral diabetes medicines or insulin therapy. They aren’t regarded as first-line treatment in diabetes, but they can be a valuable part of the overall management plan.
How They Work
Glucagon-like peptide (GLP-1) is a type of hormone known as an incretin that’s lower than normal in type 2 diabetes. GLP-1 receptor agonists belong to a class of medications known as incretin mimetics.
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By mimicking the effects of GLP-1, the GLP-1 receptor agonists have many effects.
Some of their actions include:
Help control appetite and blood sugar levelsHelp the pancreas release the optimal amount of insulin, which transports glucose (sugar) to tissues in the body where it can be used for energySlow the rate at which food leaves the stomach, which helps to control post-prandial (after-meal) blood sugar levels
GLP-1 agonists work on different organs throughout the body.
Brain
GLP-1 sends a signal to the hypothalamus, the part of the brain responsible for appetite and thirst, to take in less water and food. This can lead to weight loss.
Muscle
GLP-1 stimulates gluconeogenesis, which is the process the body uses to make glucose from protein or fat. This process lowers blood sugar by stimulating glucose uptake into the cells and increasing how efficiently the body uses insulin.
Pancreas
When GLP-1 encounters glucose, the pancreas is triggered to secrete more insulin, which lowers the amount of post-meal glucose in the blood.
GLP-1 also decreases the secretion of glucagon—a pancreatic hormone that helps to prevent blood sugar levels from dipping too low. In people with type 2 diabetes, glucagon can cause blood glucose levels to become too high.
Liver
GLP-1 lowers hepatic (liver) glucose output, which helps lower blood sugar levels.
As gluconeogenesis increases, glucagon receptors are reduced in the liver, inhibiting glucose formation and stimulating glucose uptake by cells, thus lowering the amount of glucose in the blood.
Stomach
GLP-1 decreases both the secretion of acid in the stomach and how quickly food is emptied from the stomach, prolonging the sensation of fullness. This can limit how much a person eats and may ultimately lead to weight loss.
The Different GLP-1 Receptor Agonists
There are two types of GLP-1 receptor agonist: short-acting formulas that typically are taken once or twice a day, and long-acting formulas, which are taken once a week. The type prescribed is based on a number of factors, including medical history, blood sugar control, insurance coverage, price (GLP-1 receptor agonists can be expensive), and personal preference.
If your healthcare provider prescribes a GLP-1 receptor agonist, they will teach you how to inject it yourself into either your abdomen or upper thigh. If you’re unable to give yourself a shot, someone else can administer the drug into your upper arm.
To self-inject a GLP-1 receptor agonist medication:
Examine the solution to make sure it’s clear, colorless, and has no floating particles. Check the label to make sure the expiration date has not passed. Gather your supplies: an alcohol pad, bandage, gauze, or tissue, and your prepared or mixed medication in a pen or vial and syringe. Wash your hands. Use the alcohol pad to clean the area where you’ll give the injection; rotate injection sites so that you aren’t sticking the same area over and over. Draw up your correct dose, either in the prefilled pen or syringe. Take a large pinch of skin and pull it away from the muscle underneath. Holding the pen or syringe like a dart, quickly insert the needle at a 90-degree angle to the skin. Slowly inject the medication. Release the skin, then withdraw the needle. Apply bandage, gauze, or tissue as necessary.
Side Effects
Overall, GLP-1 receptor agonists are safe and cause few side effects.
Common Side Effects
These include nausea, vomiting, and diarrhea, which affect 10 percent to 40 percent of people who take a GLP-1 receptor agonist. They are most likely to occur with short-acting medications and tend to be less severe the longer a person takes the medication.
Other potential side effects of GLP-1 receptor agonists include constipation, bloating, indigestion, and headache. There also can be some redness, itching, or soreness of the skin at the injection site.
Serious Side Effects
Although rare, these side effects should be treated as an emergency:
Ongoing abdominal or back pain, with or without vomitingA skin rash or hivesItchingPounding heartDizziness or faintingSwelling of the eyes, face, mouth, tongue, throat, feet, ankles, or lower legsTrouble swallowing or breathingHoarsenessDecreased urinationVery dry mouth or skinExtreme thirst
Complications
In animal studies, both liraglutide and dulaglutide have been shown to promote thyroid cell tumors. Although these drugs haven’t been evaluated in humans for this potential complication, it is recommended that people with a history of or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 do not use GLP-1 receptor agonists.
With certain GLP-1 receptor agonists, there is a possible small increased risk of pancreatitis (inflammation of the pancreas).
Who Should Avoid Them?
This medication is not recommended for people who:
Have a history of pancreatitis Have a history of gastroparesis (paralysis of the stomach) Have medullary thyroid cancer or multiple endocrine neoplasia type 2 or a family history of these conditions Are on dialysis (as the safety of using GLP-1 agonists in this situation hasn’t been proven)
In addition, people with impaired kidney function due to diabetes who have a GFR (glomerular filtration rate) of 30 or less should not use Bydureon or Byetta but may be able to take another GLP-1 receptor agonist.
A Word From Verywell
Living with type 2 diabetes means that you have to watch your diet, and you may need to take medication for the rest of your life. That said, controlling your blood sugar and weight can prevent complications of this very common disorder. A GLP-1 receptor agonist might be part of your overall treatment plan to help you live a healthy life.
GLP-1 receptor agonists include:
Adlyxin (lixisenatide)Bydureon (exenatide)Byetta (exenatide)Ozempic (semaglutide)Rybelsus (semaglutide)Saxenda (liralutide) Trulicity (dulaglitide)Victoza (liraglutide)Wegovy (semaglutide)
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