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GLP-1s are highly good for multitude who have type 2 diabetes or are at risk of exposure of make grow it . If you ’re considering aim them , you plausibly have lots of questions .
Here , Clifton Jackness , MD , a board - certified endocrinologist atNYU - Langone Medical Centerand assistant professor at theLenox Hill Hospitalin New York City , answer common questions about GLP-1s for type 2 diabetes , from how they work to whether insurance will cover them .
Everyday Health : What are GLP-1 agonists , and when are they recommended for masses with type 2 diabetes ?
Dr. Clifton Jackness : GLP-1s are a class of medication used to plow type 2 diabetes and obesity . The new ones are hebdomadal injections that harness the organic structure ’s own internal secretion and add to them to check parentage sugars and the amount ofinsulinthat gets secreted by pancreatic cells .
They are recommend for people with character 2 diabetes , as well as people who have elevated blood sugar levels and who have try other ways to ensure their diabetes that did n’t work .
EH : How do GLP-1s help lower lineage sugar levels ?
CJ : GLP-1 medicinal drug figure out by mime a naturally come hormone in the body that ’s also predict GLP-1 . Everyone produces it . It ’s part of a family of gut endocrine call incretins , which are activated when you eat up and drink . Incretins tell your pancreas to produce more insulin , which helps shuttle glucose from your blood stream to your cell , keeping your blood sugar steadybetween meals .
Because GLP-1s can also slow down down the rate that food and liquid move through your digestive system , they may also keep you feel entire , longer . That , in turn , prevents you from feel " hangry " between meal .
EH : How long does a GLP-1 take to part working ?
CJ : You will sense it working between 12 and 24 hours after your first injection , though it ’ll take a little longer to see a change in your blood sugar levels .
I always tell people that they ’ll experience the most side effect in the first workweek . Your appetite is very much suppressed , you may feel like there are Stone in your belly , and your cravings are almost gone . Those effects go away after the first week or two .
In the source , people often think the drugs are n’t working , but they just take a little prison term to recoil in . YourA1C should go downby at least 1.5 percentage within three month of taking a GLP-1 .
EH : What dose should I take ?
CJ : Ideally , you should set out on the lowest dose . Most people want to take the least amount of medicine and get the most benefit , and that ’s the fashion most endocrinologist do it .
Plus , there are drawbacks to taking too much of a GLP-1 decently aside . Since the drug can cause side effects , especially in the other stages , you may lose weight too chop-chop .
EH : Is there a chance I ’ll have severe side effects that cause me to stop taking the drugs ?
CJ : perhaps , but probably not . I endeavor to do a portion of counseling with my patients about the side effect and make certain they know what to expect . The most coarse side effect is nausea .
There are ways to lessen some of the side effects . For example , it helps to deplete fresh , whole food for thought . wipe out gamy - fat meals and food for thought mellow in simple sugars while take on a GLP-1 causes more diarrhea and sickness . Luckily , most people will sense likeeating whole foodsinstead of heavy , fattening foods .
EH : How do I take them ? And what if I have a fear of needles ?
CJ : Most GLP-1s are inject weekly . But they are also available in pill word form .
Some come up in automatic pens , where you do n’t see the acerate leaf . You still have to inject it , and there is a needle , but it ’s sort of hidden in an automatic chemical mechanism .
One does have a really small , 4- or 5 - millimeter penitentiary tip . It comes in more of an insulin pen - case gadget . Ten or 12 years ago , when we were trying to practice earlier forms that were daily or twice a day , we had a hard time convincing affected role to use the injection . It took a spate more time for didactics . Now , people seem to be much more willing to use the injection . There does n’t seem to be that fear of interject anymore . For most citizenry , they ’re really easy and almost pain sensation free .
As for the pill , because it ’s working with the gut hormones , it has to be take while you ’re fast . You need to take it with 4 ounces of water supply and then you ca n’t eat or drink in for another 30 transactions , so it can absorb .
EH : Are the injection pens pretty foolproof , or is there any way to mess up when using one ?
CJ : It ’s mostly unfailing . One caveat , though : The medicine need to be refrigerated , and if your icebox is too cold , the medication will stop dead and the whole mechanism will get jammed up .
EH : Is low blood sugar a possible side effect ?
CJ : Yes , but it ’s not coarse if you ’re take a GLP-1 alone . If you have diabetes and are taking it along with other medicament , specially some of the older one or insulin that are designed to lower line sugar quickly , these will unquestionably lend potency . So those other medical specialty need to be tapered , at least while you ’re starting the GLP-1 .
You might also require to wear a continuous glucose monitor to monitor your blood sugar . They have alarms if your blood sugar lead too low .
EH : Is there anyone who should n’t take a GLP-1 ?
charwoman who are pregnant also should n’t take a GLP-1 , because it ’s not approved in pregnancy . It go through the placenta . Same goes for charwoman who are breastfeeding .
Anyone who has severe gastroparesis or modern gastrointestinal constipation problem — not just occasional constipation — should n’t take a GLP-1 . And anyone with anorexia or another eat on disorder should n’t take these drug .
EH : Do I need to see an endocrinologist to get a GLP-1 prescription medicine ?
CJ : I would like to say yes , but there are n’t enough endocrinologist actively drill , and in some areas , you might not have entree to one . But your prescriber should at least be an national music primary care provider — someone with a degree who will see you in person and follow up adequately .
For 90 to 99 percent of people , these medication are comparatively safe . But to maximise the benefit , you need to have blood tests thatcheck your iron , B12 , and thyroid gland layer . The medications are dependable , but they ’re still prescriptions , so it ’s better to see a doctor in person rather than go to an online pharmacy .
EH : Will insurance always cover GLP-1s for diabetes ?
CJ : If you have character 2 diabetes with an A1C greater than 6.5 to 7.5 , your indemnity party might overlay a GLP-1 .
In my practice , we ’re completely committed to our affected role and desire them to have what they necessitate . But I ’m the ostiary , in terms of who really should be on a GLP-1 . I do n’t prescribe them to just anyone who asks . If someone has extra comorbidities or extra conditions that justify their use , we ’ll struggle for that patient . But give the cost and popularity of these drugs , the insurance companies have align with on the dot what the FDA criteria are for brood GLP-1s .
EH : Is it possible to invoke an insurance denial with the help of my doctor ?
CJ : It ’s possible , but it does n’t always work out . Insurance companies can be strict about this . Medicare , peculiarly , wants to see more long - term benefits . Medicare will cover all of the older GLP-1s for diabetes with an A1C over 6.5 three months apart , the right criteria for name diabetes .
EH : Will I be on a GLP-1 for the respite of my aliveness ?
CJ : There ’s a chance you may be . But for people with diabetes , the change in their life history are astounding and usually , they do n’t mind staying on it . If you have diabetes , you ’re go to be on some medicinal drug , so why not be on the best one for you ?
Sean Hashmi , MD , is an experienced nephrologist and obesity medicine specialist based in Southern California . As the regional music director for clinical nutrition and weight management at a prominent health care administration in Southern California , Dr. Hashmi oversee the development and carrying out of cutting - boundary nutritional programme and free weight management strategies . With his innovative approach and unwavering commitment to providing grounds - base answer , he is a highly essay - after talker and a loss leader in his athletic field .
Hashmi establish the non-profit-making constitution SelfPrinciple.org to render accessible and accurate wellness , nutrition , and health information to the public . Through this political program , he shares the latest research finding , empowering individuals to make informed decisiveness about their well - being . Self Principle also supports children ’s educational activity by allow for erudition , book , and supply , so that students have the imagination necessary to succeed academically and construct a brighter future tense .
Clifton Jackness , MD , is an attending medico in endocrinology , diabetes , and metabolism at Lenox Hill Hospital and The Mount Sinai Medical Center in New York City .
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