GLP-1s for Type 1 Diabetes? What the First Expert Guidelines Say

For years, people living with type 1 diabetes (T1D) have experienced insulin resistance, burnout, frustrating high blood sugar levels, weight gain and food cravings without much response from the medical community.

When someone is diagnosed with T1D, there is significant beta cell loss, blood sugars are dangerously high and symptoms are present. 

With that diagnosis, people with T1D are also lacking many other hormones related to fullness, insulin sensitivity and weight control, including: amylin, glucagon, pancreatic polypeptide, somatostatin and ghrelin. These are less talked about and rarely—if ever—addressed by healthcare providers.

What are GLP-1 receptor agonists and GIP medications?

Meanwhile, GLP-1 receptor agonists and GIP medications are injectable hormone medications that have been used in the treatment of type 2 diabetes and, more recently, for the treatment of obesity with great success. They help manage hunger, improve satiety and fullness, improve insulin sensitivity and aid in healthy weight loss, along with providing both heart and kidney protection. 

The conversation around these medications has evolved rapidly, from being prescribed solely for type 2 diabetes, to expanded use for the treatment of obesity, cardiovascular, kidney, and liver disease, as well as arthritis, sleep apnea and even for the treatment of substance abuse disorder. 

Are GLP-1 medications approved for type 1 diabetes?

For many people living with T1D, GLP-1 and GIP medications have quietly been prescribed by their doctors for diabetes-related comorbidities for years, usually off-label. While the practice is completely legal, off-label use means that the drug is prescribed for a condition, age, group or dosage outside of its intended Food and Drug Administration (FDA) approval. 

For people living with T1D who use a GLP-1/GIP medication off-label, it also means doing so without health insurance coverage. 

But now, for the first time, a panel of the world’s top diabetes experts convened to release a consensus statement with recommendations on the safe use of GLP-1 receptor agonists and GLP-1/GIP medications for people living with type 1 diabetes, led by Dr. Satish Garg of the Barbara Davis Center for Diabetes in Colorado and convened by diaTribe.

What did the expert panel recommend for GLP-1 use in type 1 diabetes?

While clinical trials for FDA approval for use of GLP-1/GIP medications in the treatment of T1D are ongoing, the consensus statement emphasizes several key principles for safe use in the meantime:

Insulin safety comes first

People with type 1 diabetes should never stop taking insulin while using a GLP-1 or GIP medication. Insulin doses may need to be adjusted, especially mealtime insulin, but insulin remains essential. Healthcare providers should review insulin settings regularly and make changes as needed.

Use CGM and diabetes technology to your advantage

Continuous glucose monitors (CGMs) are strongly recommended while using these medications. 

Insulin pumps and automated insulin delivery (AID) systems can also help people safely adjust insulin doses and track glucose trends as they start these medications.

Watch for ketones and DKA

People taking GLP-1 or GIP medications should know the signs of diabetic ketoacidosis (DKA), a serious diabetes complication. Blood ketone testing is recommended, especially during illness, when eating less, when insulin doses change or when blood glucose stays above 200 mg/dL for several hours. 

DKA can sometimes happen even when blood glucose levels are not extremely high.

Stay in close contact with your healthcare team

Starting a new medication often means more frequent check-ins with your healthcare team. 

Regular follow-up visits can help manage side effects, adjust insulin doses, and ensure the medication is working safely and effectively.

Be aware of digestive side effects

Some people experience nausea, bloating, constipation, diarrhea or heartburn when starting these medications. Talk with your healthcare provider if these symptoms occur, especially if you already have digestive issues such as gastroparesis.

Protect your eye health

If blood glucose levels improve quickly (0.5 in A1C drop or more), diabetic retinopathy may temporarily worsen in some people. An eye exam before starting treatment and regular follow-up eye care can help protect vision.

Focus on nutrition and strength

Because these medications often reduce appetite, it is important to eat enough nutritious foods, stay hydrated and get adequate protein. Regular strength-training exercises can help maintain muscle mass while losing weight.

Pregnancy and other considerations

GLP-1 and GIP medications are not recommended during pregnancy. If pregnancy is a possibility for you, you should discuss birth control options with your healthcare team. And before having surgery or any medical procedures done, ask your healthcare provider if your medication should be temporarily stopped.

Who should be considered for GLP-1/GIP Therapy?

For people with type 1 diabetes, GLP-1 and GIP medications may offer meaningful benefits. Success starts with ongoing insulin use, careful monitoring, education and regular communication with your healthcare team.

The consensus statement recommends GLP-1/GIP therapy for:

• Adults with T1D who have overweight or obesity (BMI of 30 or higher, or 27 or higher with other health conditions)
• Adults with T1D who aren’t hitting their blood sugar goals with insulin alone, even at a healthy weight
• Teens and young adults with T1D who have overweight or obesity and aren’t reaching their targets on insulin — or who are meeting targets but might still benefit

If your BMI drops below 25, or was 25 or under when treatment started, your healthcare provider should check in regularly and may pause or stop the medication altogether.

For dosing, the statement recommends starting at the lowest possible dose and increasing slowly. For some people, that might mean going up every few months, or not at all. Once weight and blood sugar goals are reached, the dose should be lowered to the lowest amount that still works. That dose will be different for everyone.

Lifestyle support—including physical activity and nutrition education—should be part of every GLP-1/GIP treatment plan from day one.

Who endorsed the GLP-1 consensus statement?

The statement and its recommendations were endorsed by the American Association of Clinical Endocrinology, Association of Diabetes Care and Education Specialists, Breakthrough T1D, Advanced Technologies & Treatments for Diabetes, the International Society for Pediatric and Adolescent Diabetes, and the International Diabetes Federation Europe. 

“People with type 1 diabetes are already using these therapies, but without safe use guidelines,” said Dr. Garg. “This consensus gives clinicians practical guidance to reduce risk, support individualized and collaborative care, and stresses the importance of continuing insulin therapy in patients with type 1 diabetes, despite euglycemia and normal A1C values. Our community is anxiously awaiting the completion of trials and approvals to catch up with real-world use. We hope this document will help many in the interim.” 

Why does this consensus statement matter for people with type 1 diabetes?

For years, the question was often whether people with T1D should be using these medications at all. But with these new guidelines, the conversation is shifting toward how they can be used safely and effectively. 

These medications are solving an unmet need in the diabetes community, and people with T1D need to know how to use these medications safely and effectively when they are using them.

Of course, many questions remain unanswered. Clinical trials are still underway. Additional research is needed to better understand the long-term health outcomes, ideal patient selection and the full scope of risks and benefits for people with T1D who use these medications. 

What happens next?

For now, there is no FDA approval for the use of GLP-1/GIP medications for T1D. Clinical trials are ongoing. But for the millions of people living with T1D in the United States, these recommendations are not a final determination—they are a starting point. 

This consensus statement helps establish a framework for safer conversations between patients and their healthcare team. It also offers hope that the medical community is listening to patients’ needs and they see that there are effective treatments out there, largely out of reach for many living with T1D. 

One thing is clear, however: people with T1D deserve access to every evidence-based tool that can help them live healthier, fuller lives. These new recommendations bring us one step closer to that goal. 

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