Clearing the Confusion Between Insulin Injection and GLP-1 Agonist

Image of syringes lined up in a curvy row to draw a question mark by Gordon Johnson from Pixabay.com

Pharmaceutical intervention in the treatment of diabetes is truly a lifesaver. Fourteen different drug classes are available for treating type 1 and type 2 diabetes. Some of these medications are given orally, while some are given via injection. One form of insulin is given nasally. Insulin use in type 1 diabetes is a must, due to the fact that the body does not produce insulin. Therefore, it must be replaced with insulin from outside the body in insulin injection or nasal form.

Insulin Injection

Insulin injections are given subcutaneous and are typically at least daily, maybe with mealtime. Doses are given either by insulin syringes or from an insulin pen. Insulin is measured out in “units.” All insulin injections have the potential of dropping the blood sugar by allowing sugar to go into the body’s cells for energy. Some insulins are rapid and can start acting in as little as 15 minutes. While others are long acting and can work over 24 hours.

When giving insulin, it is imperative that you have knowledge of the following. How quickly will the insulin begin to work? When will the insulin peak? How long will it stay in the bloodstream and continue to work? It is important to understand that insulin given improperly, such as at the wrong time or not given with a meal as ordered, can cause blood sugars to drop to dangerous levels.

Insulin may be used as treatment for person’s with type 2 diabetes. However, not everyone who has type 2 diabetes is on insulin. There are many pharmaceutical options for treatment in type 2; insulin is only one option. There are many oral medication choices. Again, insulin for a person with type 2 diabetes must be given appropriately to avoid low blood sugars.

GLP-1 Agonists

There is a class of medication to treat type 2 diabetes called GLP-1 agonists. Currently 6 of these GLP-1’s are injectables. Only one is in oral form. Below is a list of the medications.

Dulaglutide (Trulicity) (weekly)
Exenatide extended release (Bydureon bcise) (weekly)
Exenatide (Byetta) (twice daily)
Semaglutide (Ozempic) (weekly)
Liraglutide (Victoza, Saxenda) (daily)
Lixisenatide (Adlyxin) (daily)
Semaglutide (Rybelsus) (taken by mouth once daily)

These medications ARE NOT INSULIN. Confusion can occur because most of the GLP-1’s are injectable and it is often mistaken for insulin based on that alone. GLP-1 injections are given in “mg’s” not “units.” To make a mistake of giving insulin instead of GLP-1 can have life threatening consequences.

What do they do?

These medications improve blood sugar control by mimicking the action of a hormone called glucagon-like-peptide 1 (GLP-1). Among other things, these drugs stimulate insulin secretion in response to rising blood sugar levels after a meal, which results in lowering the blood sugar.

The most prominent effect of these drugs is that they delay the movement of food from the stomach into the small intestine. As a result, you may feel “full” faster and longer, so you eat less.

In addition to helping control blood sugar and weight loss, this class of medication may also improve your heart health. Some drugs in this class appear to lower the risk of heart disease-related death, research suggests. People taking these drugs have seen improvements in their blood pressure, cholesterol, and triglyceride levels, though it’s not clear whether these benefits are from the medicine or the weight loss.

The Mayo Clinic observed the following. “Along with helping to control blood sugar and boost weight loss, GLP-1s and SGLT-2 inhibitors seem to have other major benefits. Research has found that some drugs in these groups may lower the risk of heart disease, such as heart failure, stroke and kidney disease” ¹

Take Note

The downside to these drugs is that they must be taken by injection. Just like insulin, gastric acid will destroy the medication. They also have a risk of side effects, some serious. The more common side effects may improve after you’ve taken the medication for a while. More common side effects include:

Nausea
Vomiting
Diarrhea

Low blood sugar levels (hypoglycemia) are also a risk, but usually only if you’re taking another medication known to lower blood sugar.

This class of drugs isn’t recommended if you have a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia. Laboratory studies have linked these drugs with thyroid tumors in rats. Until more long-term studies are completed, the risk to humans is unknown. They’re also not recommended if you’ve had pancreatitis.

In closing, it is immeasurably important to be sure what injection(s) you may be giving to someone. Giving the wrong medication can have life and death consequences. Recognize the differences and clear the confusion.