GLP-1 medications like semaglutide (Ozempic, Wegovy), dulaglutide (Trulicity), and tirzepatide (Mounjaro, Zepbound) are making headlines in type 2 diabetes, but people with type 1 diabetes (T1D) are taking these medications, too. No, these medications are not approved by the U.S. Food and Drug Administration (FDA) for T1D, but nonetheless many people are taking them off-label with the full approval of their doctors.
The benefits of GLP-1 medications for T1D are now quite obvious, and yet many clinicians are still reluctant to make this medication more accessible to this population.
Here’s a closer look at why people with T1D are using GLP-1 drugs and why they keep calling it a “game changer.”
The Benefits of GLP-1 Drugs for Type 1 Diabetes
Here are a few reasons why GLP-1 medications like Ozempic can have such a big impact on T1D health and blood sugar management:
- Weight loss: Obesity is very prevalent in T1D. In fact, 62 percent of adults with T1D are overweight or obese. Managing your weight with T1D isn’t easy because you’re taking injections of insulin, a hormone that stores excess glucose as body fat!
- Hormonal health: In type 1 diabetes, your body also doesn’t properly regulate the production of five other hormones that manage your appetite, liver glucose production, satiety, insulin sensitivity, and more! GLP-1 medications help your body compensate for the misproduction of those other hormones.
- Insulin sensitivity: Many people with T1D struggle to maintain insulin sensitivity, which means you need more and more insulin to do the same job. This makes it harder to reach or maintain your A1C goals. In fact, some clinicians are also diagnosing T1D patients with T2D because of that overlapping insulin resistance and weight struggle. GLP-1s can significantly reduce your body’s daily insulin needs, making it easier to manage blood glucose levels.
GLP-1 medications are not approved for the treatment of type 1 diabetes, and some clinicians are nervous about them because they increase a person’s risk of hypoglycemia. However, many people with T1D are arguing exactly the opposite: They believe that medications like Ozempic reduce your risk of hypoglycemia because they allow you to take less insulin.
Hypoglycemia is a legitimate risk, and reducing your insulin doses is critical to starting a GLP-1 medication with T1D. If a GLP-1 increases your insulin sensitivity, you may need to reduce your insulin doses and ratios very quickly, preferably with the cooperation of your healthcare provider.
Experiences in Our Community
Over the last year, I’ve heard from many people with T1D using GLP-1s like Ozempic or Mounjaro. Every time I talk about Ozempic on my Instagram, I hear from more and more type 1s who are grateful for these medications — and they’ve shared their experiences with me through interviews and comments:
After Just Two Weeks, an Immediate Impact
Alexis has lived with T1D for over 40 years, diagnosed at only 18 months old! She started taking Wegovy just two weeks ago, but the impact on her T1D was significant and immediate.
“My average blood sugar is down from 165 mg/dL to 140 mg/dL. I’ve had some lows, too, but I just need to change my basal insulin doses, particularly in the evening.”
Wegovy is another form of semaglutide, the same drug as Ozempic, but is prescribed to people for weight loss instead of diabetes. Alexis’ BMI is over 27, so her doctor knew that her insurance was more likely to approve Wegovy for weight loss. With a coupon from Novo Nordisk, Alexis got the copay down from $200/month to just $25/month.
“My insurance company said they wouldn’t prescribe Ozempic for my type 1 diabetes because it doesn’t work for T1D,” laughed Alexis. “When my doctor prescribed Wegovy for weight loss, they said yes.”
Alexis has tried losing weight in the past without much success, perhaps due to significant insulin resistance.
“My healthcare team said I just had too much insulin on board which makes it so much harder to lose weight,” said Alexis. “I also never felt full after eating. And I had very sticky highs every afternoon that wouldn’t budge. Up around 250 mg/dL for five hours, nothing would bring it down.”
Those “sticky highs” are gone thanks to Wegovy.
“I’m not having those stubborn afternoon highs, and I’ve already lost five pounds in two weeks,” said Alexis. “I also feel so much more satisfied after eating. On Wegovy, I can eat a normal amount of food and feel full. And I can have a small snack between meals and feel satisfied.”
The only side effects she’s experienced are light nausea in the morning on an empty stomach and if she waits too long between meals.
“My blood sugar has been so much easier to manage. … I’m so impressed.”
Why a Nurse Practitioner With T1D Chose Mounjaro
Chris Szoke, a nurse practitioner and diabetes expert, has lived with T1D for over 37 years. Today, he’s also prescribing GLP-1 and GIP/GLP-1 medications like Ozempic and Mounjaro to his patients with T1D.
“Mounjaro has been an amazing drug for me. I initially just reduced my basal rate, but it became apparent to me within a month that I had to make several serious adjustments in all my insulin doses because I was that much more sensitive.”
Chris feels the most powerful aspect of this drug for people with T1D is how it shuts down the overproduction of sugar in the liver.
“The main effect of the drug that is so appealing to me is the overproduction of glucose from the liver. Personally, I notice the biggest benefits there at night. I’m also eating less, and my weight started trickling down. I’m not a heavy person to begin with, but it helped me lose a little extra weight and get a little leaner. A lot of my patients describe that they are ‘leaning out’ and losing those extra fat cells.”
Chris points to the other benefits of these medications that reach beyond diabetes and weight management.
“Now we’re learning even more and more about the benefits for cardiovascular and kidney protection. And on the neurology side, too, with reduced dementia risk and the benefits for people with sleep apnea. The benefits are pouring out from the literature.”
For people with T1D, he firmly believes that dosages should start low and be titrated up very slowly, rarely ever reaching the full “therapeutic” dosage that might be given to a person with T2D or obesity.
“As type 1s taking insulin, we definitely run the risk of hypoglycemia on these drugs, but you have to be really, really careful to increase the dosages of these meds too much or too quickly. Start low and slow. In type 1s, I don’t bring patients up to the highest dose of these drugs. I also teach a lot of my patients that these drugs work on both appetite and thirst, so you need to keep an eye on your fluid intake. Stay well hydrated!”
Chris mentioned the plateau effect, too.
“I’ve seen some patients experience a plateau in the effects after about a year,” said Chris. “This is expected, but I won’t keep increasing their dose. Stay on the comfortable dose and encourage those other lifestyle habits to help maintain the benefits. In type 1, I don’t believe we should keep pushing the dosage up.”
A Teen Using Ozempic
“My daughter uses a pump, inhaled insulin, and Ozempic,” explained mom, Kelly, about her 15-year-old daughter with T1D. “We want her to have all of the tools to manage, and some days are still really hard.”
“We reached this point in her early teens that there was enough insulin resistance causing noticeable weight gain despite a very healthy diet and very active lifestyle.”
“I wanted to help her avoid those body image and eating disorder risks that come with taking insulin plus the insane amount of insulin she needed just to correct highs and boluses for meals, and so much insulin on board. The more insulin you require, the harder it is to manage.”
Ozempic cut her insulin needs down significantly, and now it feels safer and easier to manage her blood sugar levels.
“We have a really great endocrinologist who has been so supportive of newer approaches to T1D management,” said Kelly, including looping and inhaled insulin.
Getting Ozempic was easy, because the endocrinologist documented her insulin resistance clearly and conveyed it well in the prescription details.
“She started at a very low dose, just 10 clicks, which isn’t even as much as the 0.25 [milligram] mg starting dose,” explained Kelly. “We’ve also worked with Integrative Diabetes Services for extra coaching on using it.”
Kelly’s daughter took her first injection in mid-March. Her insulin needs dropped about 20 percent almost immediately and have continued to decrease since then. Now she’s only taking about 50 percent as much insulin as she used to.
“We’ve had a few moments where we quickly had to reduce insulin doses because of lows,” explained Kelly. “You need that awareness of adjusting insulin doses quickly as things evolve. And the days right after her menstrual cycle starts can be tricky because she’s so sensitive to insulin, but needing less insulin overall means everything is easier to manage.”
Kelly credits the T1D online community for helping her learn about insulin, weight management, and insulin resistance challenges.
“You don’t learn about this from the doctor, but we’re grateful our endo is so supportive when we come to him and try these things,” said Kelly. “Anything you can do to make life a little more normal and easier to manage. All of this comes with the privilege and resources to get educated on these things and pay for these things on top of regular diabetes management tools.”
Finally Losing Weight
“I took Ozempic for a few years,” says Melissa, who was diagnosed with T1D almost 25 years ago. “It was like a miracle cure for me!”
For Melissa, Ozempic eliminated extreme fluctuations in her blood sugar levels and that constant feeling of hunger.
She’d struggled to manage her weight with diet and exercise alone. Unbeatable insulin resistance made it all feel impossible. The scale wouldn’t budge, in fact, even when trying her hardest to lose weight, she’d only gain more.
“I was finally able to lose weight because of Ozempic,” she recalls. “Before, despite eating really well, tracking calories, and exercising regularly, I was always steadily gaining weight.”
Unfortunately, Melissa had to go off Ozempic while planning for pregnancy, because it hasn’t been studied for its safety to a growing fetus.
“I haven’t had success on getting pregnant so far, and I’ve gained the weight back, along with blood sugar fluctuations like before.”
Frustrated and feeling defeated, Melissa wants to go back on Ozempic but knows her intentions to become pregnant stand in the way for now.
My Experience
I started taking Ozempic about 1 1/2 years ago. I had to go off of it for a few months when I lost insurance coverage — and that’s when I really came to appreciate how much it was doing for me.
Today, I take a teeny dose of 0.25 mg — as prescribed by my doctor. I’ve tried going up to 0.5 mg, but I just experienced stomach pain that I don’t experience at the lower dose. Since I’m not using Ozempic for weight loss, that smaller dose seems to be plenty!
It makes everything about T1D easier, with one caveat: When I eat a slow-digesting meal before bed, I tend to need a bolus in the middle of the night to prevent spiking.
Otherwise, that tiny dose of Ozempic makes it easier to stay in range, maintain my weight, feel satiated when eating, and suppress that extra sugar from my liver. I also have significantly fewer lows while taking Ozempic because it reduces my overall insulin needs, especially for meals, which means I generally have less insulin on board.
By combining a low dose of Ozempic with my daily habits around exercise and eating mostly whole foods, it just makes life with T1D so much easier.
Other T1Ds Share: Ozempic and T1D Comments From Instagram
Every time I post about Ozempic on Instagram, I receive dozens of comments from other T1Ds who are taking semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound), or dulaglutide (Trulicity). The vast majority of these comments are glowing reviews of how much these medications have helped them manage blood glucose levels more easily, improve insulin sensitivity, and lose weight.
These comments have been edited slightly for spelling or clarity:
“My time in range on Ozempic is 94 to 96 percent! I have had three lows in six months!” – Lorin
“Ozempic has been the best thing for my diabetes management and my weight. Before, I felt like I was always fighting against a brick wall.” – Jessica
“I’m on day four of the lowest dose of Mounjaro, and I’m loving it. My TIR went from 75 percent to 90 to 95 percent. Had a few side effects the second day (nausea), but other than that it’s been amazing. My endo is really supportive of these meds for type 1s and I totally trust her.” – Christina
“My need for Humalog is nonexistent, and my dose of Lantus has been cut in half. I’m in the process of titrating and haven’t had any side effects.” – Dan (LADA)
“I’m a T1D, and I’ve been on Trulicity for about a year and it’s done amazing things for my blood sugar! With the shortage, I haven’t had it for two weeks and I’m using much more insulin. I’m hoping my doc can switch me over to Ozempic soon!” – Liza
“It truly makes such a world of a difference!” – Maya
“I’ve been on Mounjaro for two weeks now. Lowest dose and I am loving how good my sugar range has been! I’m using an Omnipod so I had to set all my basal rates much lower, but it’s been great!” – Heidi
“It’s an amazing drug. Sometimes I almost feel like it’s curing my type 1 diabetes [because it’s so much easier to manage].” – Dana
“I’ve been doing this for almost a month now. I find the day after the shot I have 500 lows! This part has been tricky, but it’s getting easier. I love the appetite suppression and all my clothes are feeling so much better. My frozen shoulder seems to have dissipated! If this keeps working so well for me, I will continue forever. I’m also only taking half of the starting dose, and it’s working so well.” – Natalie
“It’s soooo helpful, and I used to take 130 units a day via my Tandem pump. Now I take 30 to 35 units via my pump, and I’ve lost and kept off 55 pounds. I’m living my best life in range! Ozempic definitely helped with my resistance. I said for years I’m so resistant, it helps me in so many ways.” – Nikki
“Loved being on it, but my insurance doesn’t cover it anymore. I definitely saw improvements with my sugars.” – Elle
“I tried it but wasn’t given any advice on managing my insulin doses so I’d go crazy low and it was so hard to get back up sometimes.” – Jules
“Ozempic is amazing for blood sugar control. Makes me feel like T1D is manageable now.” – Erika
“I’m on Mounjaro, and it’s such a game changer.” – Fernanda
“My first endocrinologist wouldn’t put me on Ozempic, but then my new and current endo let me go on it. It has been amazing for my blood sugars as a person with T1D.” – Grace
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