Type 2 Diabetes Medication Used for Type 1

1/10/17
WRITTEN BY: Jen Hanson
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Over recent years we’ve seen an explosion in new diabetes tech. From new hybrid closed-loop systems, to dual-hormone insulin pumps, to the DIY movement and OpenAPS, our ability to tailor diabetes device choices to our very individual needs has never been easier.

As we begin to experiment with highly individualized care, many in the Type 1 world are also looking to adjunct (meaning, in addition to injectable insulin) therapies to help make life a little easier. Perhaps one of the biggest challenges in recognizing the value of adjunct drug therapies in diabetes has come from the tendency in the medical world to label drugs as “Type 1”  or “Type 2.” Drugs labeled as for Type 2 diabetes are mainly pills, once daily injectables, etc., and the injectable insulin is usually labeled as for Type 1 diabetes. In reality, many of these Type-specific drugs have benefits for both diseases, and labeling them as only for one or the other creates confusion and misinformation.

Below, we’ve compiled some information to help navigate the world of non-insulin diabetes drugs. We’ve included a few of the drugs that we’ve heard — through experiences shared at Connected in Motion’s Slipstream Weekends — are being used by the Type 1 community. Of course, no single therapy is good for everyone — everyone responds differently. Get educated, talk to your diabetes team about your challenges, and keep your eye out for more advancement in this area very soon!  

Note: A generic name is given to a drug when it is approved by the FDA. A Brand Name is given to that exact same drug but is created by the company that submitted the drug for approval. For example, ibuprofen is a generic name but it is marketed by Pfizer as Advil.

 

GLP-1s: Glucagon-like peptide-1 Drugs

Brand (Generic) Names: Victoza (Liraglutide), Byetta (Exenatide), Trulicity (Dulaglutide)

COULD WORK FOR YOU IF you struggle with pre- and post-meal high BGs, are often hungry shortly after you eat.

These drugs are injectables. You’d use them anywhere from once per day to once per week depending on which one you’re using. The main function of these drugs are to (1) delay gastric emptying, (2) decrease liver glucose production, and (3) increase insulin secretion. (Of course, if you’re living with Type 1, you can scratch #3 off of your list of benefits – we’re not making insulin anyway!)

In simple terms, you’ll feel fuller for longer, and won’t get as significant BG spikes caused by your liver creating glucose in times between eating. On a very practical level, you could expect to eat less and have better BGs both before and after meals.

Many people also report feeling nauseous for the first several weeks of using the drugs. For some people this never subsides. For others, initial nausea is mild and disappears quickly. Some people also report having a more difficult time treating lows.

 

SGLT-2 Inhibitors: Sodium-glucose cotransporter-2 Inhibitors

Brand (Generic) Names: Invokana (Canagliflozin), Forxiga (Dapagliflozin), Jardiance (Empagliflozin)

COULD WORK FOR YOU IF you are interested in decreasing your insulin requirements, mild weight loss, or if you struggle with post-meal BG spikes.

These drugs are once-daily pills. What these drugs do are block the channel in our kidneys that cause excess glucose to be reabsorbed. Think of it like this: Our bodies do not want to waste energy. From an evolutionary perspective, we were built to retain energy in case we need it for an emergency later. When we have extra glucose that is being spilled into our urine, our bodies are built to reabsorb this glucose and save it for later. These drugs block the channels that allow this reabsorption and instead of keeping extra glucose, you’ll pee it out. You could expect to pee out around 300 calories of extra glucose each day if using one of these drugs. This can lead to decreased insulin requirements and decreased post-meal BG spikes.

There are significant risks associated with SGLT-2s around ketones. When using them, you could experience ketones at a ‘normal’ or within range BG. This can very quickly lead to DKA if you do not recognize and react to the signs of ketones. Most people using SGLT-2s carry blood ketone meters along with their regular BG meter. Whenever a symptom of ketones is present (headache, nausea, low energy), they are tested for immediately and treated for. This can be a steep learning curve, as many of us are used to first testing BGs when feeling ill, and if BGs are within range, moving on to assuming the cause is something else (flu, cold, dehydration, etc.)

When starting on an SGLT-2 inhibitor, you can expect to drink and pee a lot more than normal. You can also expect some weight loss. Many people have reported that this levels off after a few weeks.

 

SGLT1/2 Inhibitors: Sodium-glucose cotransporter-2/1 Inhibitors

Brand (Generic) Names: No brand name yet exists (Sotagliflozin)

COULD WORK FOR YOU IF you are interested in decreasing your insulin requirements, mild weight loss, or if you struggle with post-meal BG spikes.

This is one to keep your eyes on. This drug is currently under review with the FDA. Think of it the same as SGLT-2s, except it also inhibits the channels in your gut (these are called SGLT-1 channels). When SGLT-1s and SGLT-2 inhibitors are combined, it is suggested that the risk of ketones will be decreased. This drug has been submitted specifically for approval in the Type 1 market.

Other drugs to keep an eye out for include inhaled insulins, stable glucagons, and biosimilars. Keep your eye on the BT1 blog for more on those, coming soon!


Read about Type 2 Diabetes Management and check out The Diabetes Council.


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Jen Hanson

Jen Hanson is a registered kinesiologist, a certified teacher, and wilderness guide. She received a Master of Education degree examining the impact of experiential diabetes education and the role of community. Jen spends her days as the Executive Director of Connected in Motion, developing outdoor adventure and sport experiences for adults with Type 1 diabetes. She is an elementary lead staff with Children with Diabetes, a Faculty Member with the International Diabetes Federation’s Young Leaders in Diabetes Programme, and an outdoor educator with ALIVE Outdoors. Jen has worked as a teacher at both the elementary and secondary levels. In her free time, Jen enjoys traveling, backpacking and adventuring. In recent years, she has completed the West Coast Trail, the Inca Trail, the Long Range Traverse and several treks throughout Western Canada. In 2012, Jen was named the Reader’s Choice Adventurer of the Year by explore Magazine.