GLP-1 Agonists and Type 1 Diabetes: Everything You Need to Know

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Updated 1/23/23

Read time: 2 minutes

What Is a GLP-1 Agonist? ⁣

⁣I get so many questions about all the type 2 diabetes medications being used off-label for people with type 1 diabetes. More and more people with type 1 diabetes are using drugs meant for type 2 diabetes in addition to insulin.

The results will, ultimately, vary from person to person. But it’s definitely something you should be aware of if you’re a person with type 1 diabetes.

The first thing to know is that carbohydrate metabolism is so much more complex than just insulin or even the pancreas alone. First thing’s first. Let’s talk incretin.

What’s Incretin?

Incretins are a group of metabolic hormones that are released from our small intestine within minutes of eating. GLP-1 (glucagon-like peptide-1) and GIP (gastric inhibitory peptide or glucose-dependent insulinotropic polypeptide) are the two main ones.

One of their many functions is to stimulate the secretion of insulin in the pancreas (glucose control) and decrease food intake by decreasing gastric emptying (you feel fuller faster and for longer periods of time).

The incretin effector, the fact that oral glucose intake stimulates a greater insulin response than IV glucose intake -- occurs because there are so many other hormones released by our GI system that also impact insulin action and carbohydrate metabolism! These other hormones get dysregulated in diabetes (in both type 1 diabetes and type 2 diabetes).

GLP-1: Glucagon-Like Peptide-1

GLP-1 is an incretin made by the small intestine and released in response to food intake. It increases insulin release, decreases glucagon release, slows gastric emptying and decreases appetite.

GLP-1 diagram | How GLP-1 works in the body | One Drop for diabetes

All of this helps insulin work to better curb spikes after meals.

GLP-1 agonists are synthetic drugs (weekly or daily injectables or daily pills) that do just the same! Common side effects are nausea, vomiting and weight loss, but its main impact is reducing insulin needs and those postprandial (post-meal) blood sugar excursions!

The brand names for injectable GLP-1 agonists include Victoza, Saxenda, Ozempic, Trulicity, Byetta, and Bydureon. Rybelsus is the first-ever GLP-1 agonist in pill form.

GLP-1 agonists are increasingly being used as first line therapy for people living with type 2 diabetes.  They can also be used in combination with another medication (like insulin or metformin) to provide a modest decrease in A1C. They work on similar pathways as DPP-4 inhibitors (which stop the breakdown of endogenous GLP-1) but there is no synergistic effect if you use them both at once. ⁣

GLP-1 agonists are being used with increasing frequency in people with type 1 diabetes (T1D).

As rates of insulin resistance, metabolic syndrome, and overweight and obesity in T1Ds rise, we find ourselves with more overlap between the disease processes, and thus, more overlap with treatment.

It is important to know how and why treatments and recommendations for people with type 2 diabetes may apply to people with type 1 diabetes. Type 2 diabetes drugs can be a complementary piece of the puzzle for some T1Ds.

This article has been clinically reviewed by Alexa Stelzer, RDN, LD, CDCES, clinical health coach at One Drop.

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Jordan Hoese, MD, MPH
Feb 04, 2020

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