Must Know Facts about Non-Insulin Injectables

by David Mendosa Patient Advocate

The glucagon-like peptide-1, or GLP-1, agonists are one of the newest classes of drugs for people with type 2 diabetes. You take one of the drugs in this class by injection like you would take insulin, but much less often. This type of drug mimics the action of a hormone in your body except that it works a lot longer to enhance the secretion of insulin in managing your blood glucose.

How these drugs work

They copy the way hormones in your body help reduce post-meal blood glucose. They stimulate the release of insulin from your pancreas after you eat. They also inhibit the release of glucagon from your pancreas so your liver won’t release the sugar that it stores. The third function is to slow the absorption of glucose into your bloodstream, so you feel fuller after you eat.

They Reduce Your A1C Level

The main reason why people take any diabetes drug is to reduce their blood glucose level. The A1C test, also known as the test of hemoglobin A1C, is the gold standard to measure your level because it measures your average over the previous two to three months. When you use one of these non-insulin injectables, it will cut this level as much as if not more than any other drug.

Weight loss is a great big side effect

While all drugs have side effects, most aren’t welcomed and none are as positive for people with diabetes as the weight loss that these non-insulin injectables promote. Most people with type 2 diabetes are overweight or obese, and the people who have the highest body mass index, or BMI, generally get the greatest weight loss benefit. These are the only diabetes drugs that lead to weight loss.

More positive side effects

Losing weight is hardly the only positive side effect you can expect when you take one of these non-insulin injectables. Studies show that they can help you to reduce your blood pressure and your triglyceride levels. They also help to reduce liver fat that can lead to non-alcoholic fatty liver disease, or NAFLD, and non-alcoholic steatohepatitis, or NASH.

What doesn't happen when you take these drugs

When your blood glucose level is too low for safety, you have severe hypoglycemia. Several of the most important diabetes drugs can lead to it, but when you take one of the non-insulin injectables it happens only when taken in combination with one of the sulfonylurea drugs or with insulin. This is because these new drugs stimulate insulin secretion only when blood glucose levels are higher than normal.

A negative side effect

The most common negative side effect of taking one of these non-insulin injectables is a gastrointestinal problem like nausea. It’s likely to be mild to moderate, to occur early on, and to be transient. When the first of these new drugs came out, I was delighted to take it, but it did lead to more nausea than the newer ones. I had some nausea at first, but wrote about how to avoid and treat it.

The pancreatitis concern

Several years ago some researchers appeared to find a connection between hospitalization for acute pancreatitis and taking one of these drugs. In response the United States FDA and the European Medicines Agency reviewed the data and concluded that there is "no compelling evidence of an increased risk of pancreatitis or pancreatic cancer" and that any such connection is “inconsistent with the current data.”

Who can't use one of these drugs

Because these drugs enhance the release of insulin from the pancreas, people with type 1 diabetes can’t get their benefit. Also, people who have gastroparesis or diabetic ketoacidosis shouldn’t take it. You should also consult with your doctor if you are hoping to get pregnant as some of these drugs may not be suitable for pregnancy.

How to get access to non-insulin injectables

These drugs are available only by prescription, so you need to start by talking with your doctor. They can prescribe it as your only diabetes drug or to be used in combination with another one. Unlike every other diabetes drug -- which you have to take every day -- the newest drugs in this class work with one injection every week.

David Mendosa
Meet Our Writer
David Mendosa

David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.