I’m not sure I am posting this in the appropriate spot; feel free to move this comment to a more relevant (type 1) spot.
I have been researching the glp-1 receptor agonists and am thinking about making the argument to my PCP (who oversees my type 1) to give one of the drugs a try. Wondering if any type 1s have tried any of these? Any thoughts on my questions:
any effect on dawn phenomenon? (I am hoping that the glucagon inhibition could be seen here!) (my FOTF phenomenon has morphed into a 4:30am blood sugar rise, which is no fun (I am MDI))
did you see any improvement in your time in range?
was it a hassle to get your insurance company to pay?
any recommendations on a specific drug to try to get started on?
It is specific to T1 and it considers the merits of stuff that has a clear role with T2. The relevant sub-section is the stuff on GLP-1. My understanding of GIP, which is slightly different, comes from this article:
That suggests you need beta cells. There is stuff in the first paper about LADA and MODY. My very, very, limited understanding is that you probably want to get a C-peptide test before you start to make sure you still have some insulin production (see the C-peptide test stuff and “Figure 1” about diagnosis) and make absolutely sure you have an up-to-date diagnosis.
I’m not sure about these GLP-1 receptor agonists in particular, but off-label I use Ozempic (and previously Trulicity, which hurt like crazy, and Victoza before that) and they have helped with my food cravings (and therefore my numbers) tremendously.
I found this on diaTribe, thought it might be helpful. It seems like there is emerging clinical data on benefits of GLP-1 to type 1s (Highlights from EASD 2021 | diaTribe) (the chart didn’t format when I pasted, but is in the link)
People with Type 1 Diabetes Could Benefit From SGLT-2s and GLP-1s
Though the Food and Drug Administration (FDA) has not approved the use of either SGLT-2 inhibitors or GLP-1 receptor agonists for people with type 1 diabetes, researchers are gathering data to determine whether the benefits could outweigh potential risks.
The following three cohorts, summarized below, presented at the EASD 2021 conference included people with type 1 diabetes who used either an SGLT-2 inhibitor or GLP-1 receptor agonist. Results from the studies on these cohorts showed that liraglutide (a GLP-1 medication) was found to improve (depending on the size of the dose) glucose management, reduce body weight, and lead to reduced insulin needs when compared with a placebo.
Dapagliflozin (an SGLT-2) led to increases in TIR without any significant increase in hypoglycemia occurrences. And finally research out of Belgium showed that the use of SGLT-2s led to lower A1C, reduced weight, and reduced total insulin dose, but still resulted in a small number of diabetic ketoacidosis cases.
“I think certainly the use of SGLT2 inhibitors in people with type 1 diabetes should be considered as our data shows the importance of good patient selection,” said Falco van Nes, from UZ Gasthuisberg, in Leuven, Belgium. “Those who use insulin pumps or are at a low BMI you really have to be careful with it. It certainly has its place in type 1 diabetes but you really have to educate your patients very well and watch out for the side effects.”
So far as GLP-1 RAs are concerned those seem promising. I’m particularly interested in the basal reduction possibilities as a result of the glucagon suppression. As would be expected there is a reduction of insulin dosage (lowering the basal) and an increase in hypos (failing to lower the basal enough). There is also an increase in “ketosis”. It’s not clear that this is bad; the article says “ketosis” not “DKA” and those are very different things.
SGLT-2 inhibitors I’m extremely skeptical. So far as I can understand the limited amount I’ve read they interfere with the signaling mechanisms not the reality; they lower blood glucose by increasing excretion. (As I understand it they stop our kidneys recycling glucose into our blood, so they lower blood sugar and increase diabetes - urine sugar.) The increase in DKA is particularly worrying.
From my point of view the first adverse reaction listed in the wikipedia article is a show stopper. I grew up with poor control and had that problem most of my youth. Never again. Blood glucose, I can bolus, I really don’t want my kidneys dealing with it.
@jbowler I am 100% with you. I am interested in the GLP-1 category and not at all in SGLT-2. I think I have extended “excursions” due to glucagon release and would love to try see if I could oversee that a bit more with the ideal of few/no side effects. The “ketosis” is potentially concerning, but seemingly clearly not DKA.
I am not at all interested in messing with an SGLT-2. I had enough yeast infections when I was newly diagnosed and cannot stomach the idea of dealing with them again. And the idea of constant concern over DKA wouldn’t be worth it to me.
I passed a 2018 GLP-1 “Cell” review paper along to my biologist husband, who always has good mechanism of action insights, but he is in the middle of earnings season, so won’t be able to get to it for a bit. I’ll post his thoughts when he sends them to me.
Taking a big step back, I’ve just finished helping my daughter send in college applications and sent her off on a semester at sea and am realizing how quickly time passes and how much longer I’d like to hang out with my little family. I really want to tighten up my control and that means better TIR. Thanks for all of your thoughts here. -Jessica
TCOYD.org is offering a workshop on D meds today that might be of interest.
Are You Looking to Learn More About:
• Guidelines that healthcare providers use to decide which medications to prescribe for their patients with diabetes
• SGLT2 inhibitors such as Jardiance and Farxiga
• Oral medications that help the heart and kidneys
• GLP1RA class of medications such as Bydureon, Soliqua and Ozempic
Join us for a short, sweet, and educational Virtual Show & Tell Program all about the best medications for diabetes management, heart health, and kidney health. Make sure to invite your loved ones to join and get educated with you!
I started taking Victoza in June 2017 and switched to Ozempic in February 2019.
While I don’t think my results are necessarily typical, over the course of several months I lost over 60 lbs and my total daily insulin dose was reduced significantly (from ~90 units/day to more like 50-60 units/day now). I get way less pronounced highs after eating, and I was finally able to achieve and maintain an A1c in the low 7s after years of struggling to make it happen.
I did have VERY pronounced nausea at first and if I overdid it eating I would sometimes vomit (at least until I recalibrated my meal frequency/sizes for my new appetite and GI capacity), but overall it has definitely been worth it for me.
@CatLady thank you for posting this. I will be on another call at 7pm, but see that they allow you to replay the calls and I certainly will. This looks targeted to type 2, but I am sure there will be relevant information for type 1s as well. Thank you! Jessica
@ay0hkay it sounds like Victoza/Ozempic have been incredible for you. That is amazing. Are you on a pump or MDI? Are you doing anything else to control for blood sugar swings after eating? Did you have any challenges with insurance coverage?
I tried Symlin early on, years ago, and it was pretty magical for me in tempering BG swings after eating, but I also had the nausea problem and it caused some crazy lows.
I am on a pump (Medtronic 670G, using Auto Mode pretty much all the time).
With the use of the GLP-1RAs, I have had to somewhat “game” the algorithm a bit sometimes to keep from bottoming out after meals by giving an initial partial bolus followed by the remainder later on (I really wish Medtronic would make it possible to deliver extended and/or mixed mode boluses in Auto Mode to make this easier, but it is what it is), if I’m eating something that takes especially long to be absorbed. This would be much more difficult to do without a CGM, so that’s something to keep in mind…
As for insurance, I’ve been pretty lucky… A Prior Auth from my endocrinologist is all I’ve needed thus far. I am in the process of changing my insurance again as we speak (moving to my wife’s plan out of necessity) so I’ve got my fingers crossed that’s all I’ll need again - but I won’t know for another few weeks.
-Jessica