DREAM Team Newsletter

September 2024 | Issue 7.1

GLP-1 RECEPTOR AGONIST. WHAT DO I NEED TO KNOW?

By Jay Shubrook, DO

If you read the news recently it would be hard to miss some story that focused on medicines like Ozempic or Mounjaro. These medicines are part of the medication class called GLP-1RA. There are eight different medications in this class even though most people have only heard of one or two. They were initially developed to treat type 2 diabetes and are very effective medicines for this indication. However, we've now learned that they have many beneficial effects. These include:

• Weight loss

• Cardiovascular protection

• Kidney disease protection

• Maybe liver protection for MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease)

• Maybe protection for cognition

• Maybe benefit for heart failure

While the beneficial effects of these medications have made a lot of us excited, it is important to recognize that they do have side effects. These medications commonly can upset the stomach and cause nausea, loss of appetite, vomiting, diarrhea, or constipation. It is also important to recognize that people who have a history of pancreatitis, excessive alcohol intake, or a history of gastroparesis would be warned against using these agents. Further, those who have a rare thyroid cancer syndrome (medullary thyroid cancer) cannot take these medications.

With the recent indications for weight loss and the great popularity because of their significant effect on weight loss, these medicines have become incredibly popular even in people without diabetes. While it is great to be able to help more people, it has made access to the medications much harder even for people who are already on established therapy. This has made steady access to the medications quite challenging.

Currently most people who start diabetes medications will stay on them as long as they have diabetes. This is true for these medications as well but sometimes once weight loss has occurred patients are able to do more lifestyle changes and able to reduce their medications. This should be done in collaboration with your healthcare professional.

If you are interested in starting one of these medications or are already taking one, there are a few things that you can do to give you the best chance for success.

1. Speak with your healthcare professional about the risks and benefits of this medicine specific to you in your situation.

2. Make sure that you have some coverage for these medications because they are rather expensive.

3. If you choose to start one of these medications, make sure that you know it's going to affect your appetite and your sense of feeling full. Best practices would mean that you would eat more slowly, try to avoid high fat foods, and stop eating as soon as you feel satiated.

4. If you experience side effects and they're mild they're very likely to go away within a number of weeks. Following the recommendations above can reduce some of those side effects.

5. If you have side effects that are more severe contact your healthcare professional immediately as they may recommend that you stop the medication, and they look for an alternative.

DIABETES CAMP

A PLACE WHERE DIABETES DOESN'T MAKE KIDS FEEL DIFERENT

Have you ever been somewhere where EVERYONE else was different than you? Especially if you were a child or adolescent. This is the lived experience for many people with type 1 diabetes.  Many people with type 1 may not know any peers who also have type 1 diabetes (only affects 0.3-0.4% of the population). This is often exacerbated by many people unaware of the cause of type 1 diabetes and how it is vastly different than type 2 diabetes.  How can we build a network and normalize the type 1 diabetes experience?

Diabetes Camp!! Yes, a camp. Diabetes Camp is like any other camp but for people with type 1 diabetes. As at any camp, kids will hike, swim, play games, go on adventures, stay in bunks, get too little sleep and eat “camp food". But at diabetes camp – all of the campers also have type 1 diabetes, so they count carbs, take insulin for meals, might experience hyper or hypoglycemia, and get to meet people just like them. Kids will learn tips and tricks from each other, the camp staff, and the medical team, who also typically will have type 1 diabetes. For many kids this may be the first time they are out overnight without their parents. This is a big adjustment for both the kids and family. Kids feel like they belong, and other people understand them.  The DREAM team routinely participates in Diabetes Camps. This year, Dr. Wong, Dr. Dongmo Fotsing, and Dr. Shubrook participated in the DYF camp in the Santa Cruz Mountains. Dr. Belec, Dr. Dudenhoeffer and Dr. Shubrook went to the T1Diabetes Buddy camp in Bend, Oregon. In addition to having an outstanding time at camp our team gains valuable insight into the day-to-day life of a person with diabetes. We are so fortunate to have this opportunity.

Newsletter Credits

Editor: Sumera Ahmed, MD      

Designer: Maryelli Ray

Sponsored by: Sutter Health