What is GLP-1? For who is it? What do you need to know about it before you talk to your doctor? Read the answer!
I know that many of our community members have questions about GLP-1, so we asked endocrinologist Professor Peter Laubenheimer to answer all of them.
What are GLP-1 agonists?
GLP-1 agonists are a group of drugs that help manage blood glucose levels in patients with type 2 diabetes, some of which can be used by people who do not have diabetes to treat obesity.
There are several other names used for these drugs:
Incretin Mimetics GLP-1 analogue GLP-1 receptor agonist GLP-1 glucagon-like peptide-1 agonist is simply referred to as GLP-1.
List of GLP-1 agonists
The following are the GLP-1 agonist drugs currently available in South Africa:
Dulaglutide (Trulicity®) Exenatide (Byetta®) Liraglutide (Giliptra®, Victoza®, Saxenda®) Semaglutide (Ozempic®) lixisenatide: Brand name Soliqua. Tilzepatide (Mounjaro®) – Tilzepatide is a double agonist that targets both GIP and GLP-1 receptors. It belongs to a new class that is different from GLP-1 receptor agonists.
Some drugs combine GLP-1 receptor agonists with insulin in one daily injection. These are primarily used in people with type 2 diabetes who require stronger glycemic control than either drug can provide alone. Various medications are indicated for a variety of treatments. Talk to your doctor to find out more about what's best for you.
Examples of concomitant medications:
This gives a detailed look at what GLP-1 is available in South Africa.
How do GLP-1 agonists work?
GLP-1 represents glucagon-like peptide-1. It is a natural hormone produced in your body, especially in the intestines, after you eat. It helps to control your blood sugar and reduce your appetite.
GLP-1 plays several useful roles:
Lowers blood sugar levels after meals: It helps your pancreas release insulin only if necessary, especially after eating. Slow digestion: This means that food will stay in your stomach for a long time. Reduce appetite: It affects the brain areas that control hunger and helps you feel hungry. Lowers Glucagon: Glucagon is the hormone that develops blood sugar levels. GLP-1 helps to suppress this.
GLP-1 agonists function by mimicking this hormone.
What is GIP?
GIP is a glucose-dependent insulinotropic polypeptide, also known as a gastric inhibitory polypeptide. It is a hormone that stimulates the release of insulin into the bloodstream, and once food is registered in the body, it controls blood glucose levels after meals. If you have type 2 diabetes, GIP hormone release is inefficient and does not function effectively.
One of the currently available drugs for managing type 2 diabetes in South Africa is Mounjaro®. Mounjaro® is a double receptor agonist that binds to both GLP-1 and GIP receptors.
As a result, the binding of both GLP-1 and GIP allows for more effective use of insulin and better management of post-meal blood glucose levels. Together, the binding and activation of two different receptors complement each other and regulate appetite, insulin sensitivity, and insulin release.
Who will be prescribed GLP-1?
Doctors may prescribe GLP-1 agonists to people such as:
You suffer from type 2 diabetes, especially if other drugs, such as metformin, are not sufficient, which are used first. Overweight or obese, especially if you also have diabetes or other health risks (though Trulicity and Mounjaro are not shown for treatment of overweight or obesity).
Although these drugs are not approved for use in people with type 1 diabetes, researchers are currently studying the safety and efficacy of type 1 people.
Currently, medical aids do not contain GLP-1 agonists in PMB care's PMB packages, so payments are usually made to the patient's own account. The public sector of SA currently does not offer GLP-1 agonists.
How is GLP-1 taken?
Most are injections, usually once a day or once a week. The new format of Semaglutide (Rybelsus®) is available as a daily tablet, but is not available in SA yet. The injection is given under the skin (not in muscles or veins). Your doctor or pharmacist will show you how to use it safely.
What are the advantages?
Better blood sugar control
GLP-1 drugs can lower HBA1C levels (a marker of average blood glucose levels over three months) and help keep blood glucose levels within normal ranges. Weight loss
Most people lose weight at 5-15% of their weight over time, especially due to lifestyle changes. Cardiac protection
Triulacea reduces the risk of heart attacks and strokes, especially in people with type 2 diabetes and heart disease. (Find out more about whether people with diabetes need to worry about their heart health). Convenient administration
Some weekly infusions of GLP-1 are low dosage and easy to do.
What are the side effects?
Like all drugs, GLP-1 has side effects. The most common are:
Nausea Vomiting Diarrhea Constipation Bloody or indigestion
These usually improve over time. Taking medication with food or starting at a low dose may help.
Serious but rare side effects:
Pancreatitis (inflammatory pancreatic) Cholecystitis Problems Hypoglycemia, especially if the insulin or sulfonylurea allergic reaction is worsened, and if diabetes-related retinopathy is worsened
If you have an indelible stomach pain, always consult your doctor,
Skin, or signs of hypoglycemia (such as anxiety or confusion). Here are some common things
Symptoms of hypoglycemia.
FAQs about GLP-1
Q: Should I take GLP-1 medication forever?
A: Not always. Some people stop after achieving their goals, others need them
Long-term or alternative treatments. Most people regain lost weight
When stopped by these drugs. Your doctor will help you decide.
Q: If I use GLP-1, can I stop diabetic tablets?
A: In some cases, GLP-1 drugs reduce the need for other diabetes medications. Don't stop taking your medication without asking your doctor.
Q: Is GLP-1 addictive or dangerous?
A: Usually not. They work by mimicking the body's natural incretin hormones and are generally safe to use under medical supervision.
Q: Are they the same as insulin?
A: No. GLP-1 helps the body release its own insulin, but it is not insulin. Here's what you need to know about starting insulin in type 2 diabetes.
Q: Can I take GLP-1 instead of insulin?
A: If you have type 2 diabetes, you may be able to do it after discussing it with your doctor. If diabetes requires treatment with injections, GLP-1 is an option instead of insulin injection, but insulin therapy is still clinically indicated or necessary. However, GLP-1 is currently not funded in the South African healthcare environment and may therefore not be available. There is no “best” way to manage type 2 diabetes. Your doctor will discuss treatment plans for you.
What do you think?
Have you tried the GLP-1? Are they working for you?
What do you read next?
Type 2 diabetes and insulin: Don't be scared, here's what you need to know: Do you think you might be ready for insulin? Read this to see more details.
10 Fast Facts about Hypoglycemia (Hypoglycemia): Don't know what Hypo is? This is the explanation.
What is Teel? Easy Ways to Manage Diabetes: Teel offers four rules for managing diabetes.
Image credits from Unsplash
Discover more from South Africa with diabetes
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