​A Beginners Guide To GLP 1 Analogue Medications Like Semaglutide And Tirzepatide

INTRODUCTION

In the realm of modern medicine, groundbreaking discoveries continue to revolutionize the way we approach and treat various health conditions. One such discovery is the class of medications known as GLP-1 medications. These agents have emerged as powerful tools in weight loss, managing diabetes and hold promise in addressing other metabolic disorders. This blog post aims to explain the basics of GLP-1 medications, shedding light on their mechanism of action, therapeutic applications, and potential benefits.

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​UNDERSTANDING GLP-1 AND ITS ROLE

​GLP-1 stands for glucagon-like peptide-1. It is a natural hormone produced by the human body, primarily in the small intestine. At a very basic level, its significance lies in its role in glucose homeostasis, or the regulation of blood sugar levels. When a person eats, GLP-1 is released, which helps stimulate the production of insulin from the pancreas. Insulin, in turn, helps cells take in glucose (sugar), reducing blood sugar levels.
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GLP-1 also affects digestion in other ways, such as by slowing down gastric emptying (how quickly the stomach pushes food into the small intestine), which helps control the rate at which nutrients are absorbed. Additionally, it inhibits the release of glucagon, a hormone that raises blood sugar levels. Glucagon and insulin work opposite of each other to keep your blood sugar levels in balance.  All of these various mechanisms combined contribute to the overall maintenance of blood glucose levels within a narrow, healthy range. More on this in a future post.

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​THE BIRTH OF GLP-1 MEDICATIONS

​As researchers dug deeper into the intricate details of metabolic regulation, they recognized the potential benefits of enhancing the effects of GLP-1 in people with diabetes. This led to the development of GLP-1 medications, synthetic compounds that mimic the action of the natural hormone. By using these compounds, doctors aim to help patients with type 2 diabetes better manage their blood sugar levels. What was later realized was that these medications also have a significant impact on weight loss.

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​HOW GLP-1 WORKS ON THE BODY

GLP-1 medications function by binding to and activating the GLP-1 receptors on the surface of pancreatic beta cells. This activation triggers a cascade of events that collectively contribute to improved glucose regulation. The key mechanisms of action of GLP-1 medications include:

• Insulin Release: GLP-1 medications enhance insulin secretion from pancreatic beta cells in response to elevated blood sugar levels. This helps the body respond more effectively to ingested carbohydrates, preventing excessive spikes in blood glucose.
• Glucagon Suppression: GLP-1 medications inhibit the release of glucagon, a hormone that promotes the release of glucose into the bloodstream. By reducing glucagon levels, GLP-1 medications can help decrease excess glucose production by the liver.
• Gastric Emptying Delay: GLP-1 medications slow down the rate at which the stomach empties its contents into the small intestine. This delayed gastric emptying helps regulate the absorption of nutrients, preventing rapid increases in blood sugar after meals.
• Decrease Cravings: GLP-1 medications also have an effect in the brain and help reduce the feeling of hunger and also decrease food cravings.  

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​COMMON GLP-1 MEDICATIONS 

Several GLP-1 medications have gained approval for clinical use, each with its unique characteristics and administration methods. Some of the notable GLP-1 medications include:

• Exenatide (Byetta): Administered by subcutaneous injection, exenatide is available in both immediate-release and extended-release formulations, allowing for once-weekly dosing.
• Liraglutide (Victoza): This daily injection is known for its efficacy in reducing both fasting and postprandial glucose levels. Liraglutide has also been approved for weight management.
• Dulaglutide (Trulicity): Administered weekly via subcutaneous injection, dulaglutide offers convenience to patients and has demonstrated significant reductions in HbA1c levels.
• Semaglutide (Ozempic/Wegovy): Available in both subcutaneous and oral formulations, semaglutide is very effective in lowering blood sugar levels and has the added benefit of once-weekly dosing in its injectable form.
• Tirzepatide (Mounjaro/Zepbound): Administered weekly via subcutaneous injection.  This is the newest GLP-1 medication and also has another mechanism of action that the others do not, which enhances the weight loss effects. This second mechanism is called glucose‐dependent insulinotropic polypeptide (GIP) which works similarly to GLP-1 by stimulating insulin production and secretion.  Studies have shown that weight loss can be achieved a bit more effectively and sooner than with the other GLP-1 medications. 

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​THERAPEUTIC APPLICATIONS

Historically, GLP-1 medications were primarily prescribed for individuals with type 2 diabetes, especially those who struggled to achieve adequate blood sugar control with oral medications alone. They are still often prescribed when lifestyle modifications and other oral antidiabetic agents are insufficient.  

Recently, studies have shown that GLP-1 medications are very effective in treating obesity and other metabolic disorders.  These medications are becoming more popular and quite successful in treating individuals with a BMI over 27.  Some studies also show that there are benefits to cardiovascular (heart) health, including a reduction in the risk of major cardiovascular events such as heart attacks. 
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Because GLP-1 medications can reduce food cravings, they are also being studied and used to treat people with drug and alcohol addiction with success.  This is still being further investigated as it is still in its infancy.

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​BENEFITS OF GLP-1 MEDICATIONS

• Improved Glucose Control: By enhancing insulin secretion and suppressing glucagon release, GLP-1 medications contribute to better glucose control, reducing HbA1c levels.
• Weight Loss: GLP-1 medications are associated with weight loss, making them an attractive option for individuals who are overweight or obese.
• Cardiovascular Protection: Emerging evidence shows that GLP-1 medications have cardiovascular benefits, reducing the risk of major cardiovascular events in patients with established cardiovascular disease.
• Convenience: With formulations allowing for once-weekly dosing, GLP-1 medications offer a convenient treatment option for individuals who prefer less frequent injections.

It should be noted that one's overall health dramatically improves with weight reduction therefore the increase in longevity is arguably the best long term benefit.  

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​COMMON SIDE EFFECTS

​While GLP-1 medications offer significant advantages, it's essential to consider potential side effects and contraindications. Common side effects may include nausea, vomiting, diarrhea, and/or constipation, although these symptoms often diminish over time. Patients with a history of pancreatitis or thyroid cancer may need careful evaluation before initiating treatment with GLP-1 medications.

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​CONCLUSION

In the dynamic landscape of weight loss and diabetes management, GLP-1 medications stand out as a remarkable addition to the treatment options available to healthcare providers. Their ability to harness the body's natural mechanisms for glucose control, coupled with additional benefits of weight loss and potential cardiovascular protection, positions them as valuable tools in the holistic care of individuals who have or are at risk of developing type 2 diabetes. As research continues to unveil more about these agents, the future holds promise for further advancements in metabolic medicine, ultimately benefiting the lives of those affected by being overweight in addition to diabetes and related conditions.