For a long time, the main treatment for type 1 diabetes has been insulin. While insulin is absolutely necessary and life-saving, many people find it difficult to reach their blood sugar goals or manage their weight while using it. Because of this, doctors are looking at “adjunctive” therapies—extra medications originally made for type 2 diabetes that might help people with type 1 as well.
Why Consider Other Medications?
Although modern technology like new insulin types, insulin pumps, and wearable glucose monitors have been game-changing, many people with type 1 diabetes struggle with weight gain or sub-optimal blood sugar levels. Adding a second medication can sometimes help:
- Weight Loss: Some newer drugs can help reduce appetite and lead to meaningful weight loss.
- Smoother Blood Sugar: These drugs may help lower A1C levels (a measure of average blood sugar) without causing more “lows”.
- Lower Insulin Doses: Using these medications often allows a person to use less insulin overall.
GLP-1 Receptor Agonists and SGLT2 Inhibitors
There are two main groups of drugs being studied. The first are the GLP-1 receptor agonists, which mimic a hormone that tells the brain that a meal has just been eaten, reduces appetite, and slows down how fast the stomach empties. The second are the SGLT2 inhibitors, which help the kidneys flush extra sugar out through urine.
While these drugs sound promising, they are currently “off-label” for type 1 diabetes. This means they aren’t officially approved for this use yet.
They may also cause acute side effects when used for type 1 diabetes. The biggest concern is a dangerous, life-threatening condition called Diabetic Ketoacidosis (DKA). This serious problem can occur in anyone with type 1 diabetes due to infection, dehydration, medical stress, or vomiting, due to a variety of drugs or other causes.
The risk of it occurring is particularly increased by the SGLT2 inhibitor drugs. Because of this risk, these medications are usually only considered for people who are highly motivated, check their sugar levels often, and are willing to monitor their “ketones” (a chemical the body makes when it burns fat for energy instead of sugar).
About the author
Reema Shah