Dual GLP-1/glucagon agonist

Diabetes medicines: GLP-1 agonists

This information is about medicines called glucagon-like peptide 1 (GLP-1) agonists. It explains how these medicines, together with healthy lifestyle changes, can help you to manage type 2 diabetes.

The information covers:

• how GLP-1 agonist medicines work
• taking GLP-1 agonist medicines
• side effects of GLP-1 agonist medicines
• treatment aims and how we monitor you
• healthy changes to your diet

We also have a booklet called "GLP-1 agonist medicines for diabetes", which you or your healthcare professional can print.

If you have any questions, please speak to your healthcare professional.

How GLP-1 agonist medicines work

GLP-1 agonists are medicines used to treat type 2 diabetes. They mimic (copy) the action of a hormone (chemical substance) called GLP-1. Your stomach naturally releases this hormone when you eat food.

The medicines work in different ways. They:

• help your body to make more insulin (the hormone that controls the amount of sugar in your blood) when needed
• reduce the amount of sugar (glucose) that your liver makes
• slow down the digestion of food, so that it takes longer for your body to absorb (take in) the sugar from meals
• can reduce your appetite

You can take GLP-1 agonist medicines as injections or tablets.

If you have injections, your healthcare professional will tell you the best place to inject the medicine. This may be under the skin in:

• the front of your thighs
• your tummy (abdomen)
• your upper arms

If you have tablets, you take a tablet 1 time each day when you wake up on an empty stomach. You swallow the tablet with a sip of water (no more than half a glass or 120ml). Please wait for at least 30 minutes before eating, drinking or taking any other tablets.

You healthcare professional explains:

• how much medicine to take (the dose)
• when to take the medicine
• how often to take the medicine

We give you a printed patient booklet, where you can keep a record of the instructions for taking your medicine.

We may need to make some changes to your other diabetes medicines. We explain these changes to you and list them in your printed patient booklet.

Make sure that you keep taking all your other medicines as before, unless we tell you otherwise.

Side effects of GLP-1 agonist medicines

Before you start taking GLP-1 agonist medicines, it is important that your diabetic eye screening is up to date. This is a test that you have every year to check for eye problems caused by diabetes. Please tell your healthcare professional if there are any concerns about your eyes before you start GLP-1 agonist medicines. They can then make sure that you have the most suitable medicines to treat your diabetes.

The patient information leaflet that comes with your GLP-1 agonist medicines has a full list of possible side effects. You are unlikely to have all the side effects listed and may not get any of them.

The most common possible side effects of GLP-1 agonist medicines include:

• feeling sick (nausea) and diarrhoea (these usually go away with time)
• stomach pains
• constipation (when you find it hard to poo or go to the toilet less often than usual)
• having less appetite
• low blood sugar (hypoglycaemia or hypos)
• headaches
• skin reactions if you inject your medicine

Stop taking the medicine and contact a doctor immediately if:

you have severe and long-lasting stomach pain (which might reach through to your back), with or without being sick (vomiting). This may be a sign that your pancreas is inflamed.

You can make a note of any side effects in your printed patient booklet. Please talk to your healthcare professional about them.

Treatment aims and how we monitor you

GLP-1 agonist medicines can improve your blood sugar control if you have type 2 diabetes. They can also help you to lose weight, together with diet and healthy lifestyle changes.

We usually prescribe these medicines for people with type 2 diabetes, whose blood sugar levels cannot be managed effectively with tablets.

We take some measurements before you start the GLP-1 agonist medicine and then repeat them after 3 and 6 months:

• Glycated haemoglobin or HbA1c (this blood test measures how well your diabetes has been controlled over the past 3 months).
• Your weight.
• How well your kidneys work (we do a blood test to help us estimate how many millitres of waste your kidneys can filter in a minute).

These measurements help us to see if the medicine and lifestyle changes have improved your diabetes control. We can also check for any side effects of the medicine.

In your printed patient booklet, we record the targets for your blood sugar control and weight loss after 6 months. We then review if you have met these targets.

Healthy changes to your diet

To help you manage type 2 diabetes, lose weight and stay healthy, you may need to make changes to your diet.

Do

• eat small, regular meals and spread your food over the day
• choose high-fibre, starchy foods, such as wholegrain breads and cereals, beans, peas, lentils and oats
• eat fruit and vegetables every day
• include vegetables or salad with each meal
• spread the fruit that you eat over the day because all fruit contains natural sugar
• use small amounts of mono-unsaturated fats and oils, such as olive oil and rapeseed oil (vegetable oil)
• eat fewer fried foods and cut fat off all meat
• eat leaner (less fatty) meats, such as chicken or turkey
• use artificial sweeteners instead of sugar, honey, glucose or fructose
• replace energy drinks, Lucozade and malt drinks with diet or no added sugar varieties

Don't

• do not have large portions of starchy carbohydrates, such as potatoes, bread, rice and pasta. Add extra vegetables or salad to your plate instead
• do not drink more than about 125ml of fruit juice a day because it contains natural sugar
• do not eat large amounts of saturated fats, such as butter, lard,ghee, red palm oil, pastry, cheese, crisps, mayonnaise and cakes
• do not eat too many sugary foods and drinks
• do not eat too much salt. Flavour food with pepper, garlic, herbs and spices instead
• do not drink more than 14 units of alcohol a week, which you should spread over 3 or more days. 14 units are about 6 pints of average strength beer or 6 medium (175ml) glasses of average strength wine

Dinner plate model to help with weight loss

A healthy dinner plate is made up of these types of foods:

• Half the plate (50%) should have vegetables, salad or fruit.
• One-quarter of the plate (25%) should have protein, such as meat, fish, eggs, beans or lentils.
• One-quarter of the plate (25%) should have starchy carbohydrate foods, such as bread, potatoes, pasta, rice, yams or cassava.

Making healthier food choices

This table gives you guidance on replacing some foods with healthier choices.

Booklet for people taking GLP-1 agonist medicines

You or your healthcare professional can print our booklet called GLP-1 agonist medicines for diabetes. This has been designed for people with type 2 diabetes taking GLP-1 agonist medicines.

The booklet can help you to monitor and manage your condition with a healthcare professional’s support. There are various sections that you and your healthcare professional can complete together. For example, you can:

• write important information about the GLP-1 agonist medicine that has been prescribed for you
• make a note of any side effects
• list any changes to your other diabetes medicines
• record the measurements that we take to monitor your health (your blood test results and weight)
• set targets for your blood sugar control and weight loss over 6 months
• plan the changes that you will make to have a healthier lifestyle

Related content

• GLP-1 analogues – Diabetes UK
• Type 2 diabetes – Conditions - NHS
• Food and keeping active – Type 2 diabetes - NHS
• What is a healthy, balanced diet for diabetes? – Diabetes UK