Injectables for Type 2 Diabetes: Options, Risks, and Effects

What GLP-1 medications are available?

There are currently several GLP-1 and dual GIP/GLP-1 medications approved for type 2 diabetes that differ in dosing schedules and durations of action.

* Tirzepatide is a dual GIP/GLP-1 receptor agonist.

Pramlintide (Symlin) is another injectable drug approved for the treatment of type 2 diabetes. It’s used in conjunction with mealtime insulin shots. Though less commonly prescribed, it works similarly to GLP-1 medications.

GLP-1 medications may help delay gastric emptying, increase feelings of fullness (satiety), reduce cholesterol, and lower both systolic and diastolic blood pressure.

Do GLP-1 medications always affect body weight?

Unlike insulin and other diabetes medications, injectables do not cause weight gain.

Because they decrease appetite and slow stomach emptying, they can contribute to substantial weight loss.

In clinical trials for type 2 diabetes, individuals taking these medications frequently lose between 12.8% and 14.7% (or more) of their starting body weight. This often averages 28 to 33 or more pounds (lb), depending on the specific medication and dose. The amount of weight loss depends on multiple factors, such as:

• diet
• exercise
• use of other medications

Because of this, GLP-1 medications are suited for people who are overweight. They’re often used in combination with other drugs or insulin to reduce the chance of weight gain.

Medical Perspective

“While many people will experience weight loss [on GLP-1 medications], some will experience minimal effects. This can be due to factors like lifestyle (for example, diet and activity level), how the individual person’s body responds to GLP-1s, and even the GLP-1 used.

— Philip Ngo, PharmD

How to Track Weight Loss on a GLP-1 Medication

_{Quotes represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.}

Is the GLP-1 dosage the same for injectables?

GLP-1 medications are available in prefilled pens that you administer yourself, similar to administering insulin. They differ by dosage and duration of action.

Your doctor will likely start you off with a low dose and gradually increase it based on your reaction to the drug and its effectiveness. They’ll do this until you’ve reached the smallest amount that achieves the desired effect.

Here’s how it usually works:

• Frequency: Most of these medications are taken once per week, though some like liraglutide (Victoza) are taken daily.
• Injection site: These medications are given via subcutaneous injection (under the skin), usually in the abdomen, thigh, or upper arm.
• Process: You’ll clean the area, dial the dose (if applicable), and inject the medication with a pen that has a very fine needle.

Your doctor or pharmacist can walk you through the first injection or give you a demo. There are also videos and step-by-step injection guides on the drug manufacturers’ websites.

Are there side effects to injectable medications to be aware of?

Gastrointestinal side effects, such as nausea, vomiting, and diarrhea, occur in many patients taking GLP-1s. Nausea may lessen over time or with a lower dose. It may also occur less frequently with medications that are taken weekly (versus daily).

Other side effects may include:

• dizziness
• mild tachycardia (increased heart rate)
• infection
• headache
• indigestion

Some GLP-1 drugs may cause local skin reactions at the injection site.

Hypoglycemia rarely occurs with GLP-1 medications when used alone. However, adding them to insulin-based therapies may increase this risk.

Doctors recommend that people who may become pregnant use contraceptives while taking GLP-1 drugs.

How much do injectable medications cost, and are they covered by insurance?

Injectable GLP-1 medications are expensive. However, generic options have begun to enter the market. The first generic versions of once-daily liraglutide (the generic equivalent of Victoza) are now approved by the Food and Drug Administration (FDA) and available for use. Newer once-weekly brand-name injections do not yet have generic alternatives.

The price of these medications can vary by pharmacy and by insurance provider and plan. It’s good to become familiar with the specifics of your prescription drug plan to see which medications may be covered.

Takeaway

Injectables like GLP-1 medications are used to treat type 2 diabetes. Most of these drugs are given daily or weekly and administered by the person using them.

Like other medications, GLP-1s may cause side effects, including nausea and diarrhea.

In addition to medication, a doctor may recommend lifestyle measures, such as following a specific diet and adhering to an exercise plan, to manage type 2 diabetes.