Understanding the Benefits and Side effects of Semaglutide in Type 2 Diabetes

Why are blood sugar levels too high when you have type 2 diabetes?

The pancreas secretes a hormone called insulin, which plays a crucial role in regulating blood sugar levels (glycemia). In individuals with type 2 diabetes, the pancreas may not produce sufficient insulin to maintain normal blood glucose levels, or the body may become resistant to insulin's effects. This can lead to persistently elevated blood glucose levels (hyperglycemia), which can damage organs such as the heart, kidneys, eyes, and nerves.

The objective of managing type 2 diabetes is to rapidly normalize blood glucose levels (within 3 to 6 months of diagnosis) to prevent or delay the progression of complications.

How does semaglutide work?

Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1 RA). This class of drugs is designed to reduce blood glucose levels by stimulating insulin production by the pancreas and inhibiting the secretion of glucagon, another hormone produced by the pancreas which can increase blood sugar levels.

Who should take a GLP1-RA such as semaglutide?

There are several GLP1-RAs on the market in Canada that are used to treat type 2 diabetes. All of these drugs can be used to lower blood glucose levels, usually in combination with other diabetes medications.

Studies on GLP1-RAs have found that three of them (dulaglutide, liraglutide, and semaglutide) are also associated with a lower risk of major cardiovascular events, like a heart attack or stroke.  This is significant, because cardiovascular disease is the primary cause of death in people with type 2 diabetes.

In its treatment guidelines, Diabetes Canada recommends that individuals diagnosed with type 2 diabetes who have experienced a significant cardiovascular event, such as a heart attack or stroke, or who are at an elevated risk of such an event, should include one of the GLP1-RA medications with proven cardiovascular benefits into their therapeutic regimen. If you want to know your cardiovascular risk level, talk to your healthcare professional.

GLP1-RAs may not be suitable for people with certain health issues, such as a history of pancreatitis. Your pharmacist will make sure that the medication you're prescribed is right for you.

How are semaglutide and other GLP1-RAs administered?

GLP1-RAs should be administered subcutaneously, either once a day or once a week depending on the product. Semaglutide is the only GLP1-RA also available in tablet form for the treatment of type 2 diabetes. However, the tablets must be taken every day, whereas the injectable version of semaglutide is administered once a week.

Don't worry about injectable drugs! They are now available in easy-to-use devices and thanks to the very fine needles, injections are painless.

What are the side effects of semaglutide and other GLP1-RAs?

As GLP1-RAs slow the movement of food from the stomach to the intestine, they may cause nausea, which can sometimes lead to vomiting. Diarrhea is also a possibility. These side effects usually subside with time. If they don't, your pharmacist can help you manage them.

Weight loss, a beneficial side effect of GLP1-RAs

GLP1-RAs have been shown to increase satiety and reduce hunger, helping people feel fuller and eat less. This can lead to significant weight loss, which is a beneficial side effect of type 2 diabetes treatment, as many people with type 2 diabetes are overweight.

Weight loss can be beneficial on many levels, especially in people who have obesity-related complications in addition to their diabetes. Here are a few examples:

• Weight loss helps to improve control of blood sugar levels, which can help reduce the amount of medication needed to reach treatment goals.
• Weight loss can have a positive impact on blood pressure in people who also suffer from hypertension.
• In the presence of osteoarthritis, particularly in the hips or knees, weight loss can help reduce the stress on these joints and thus the pain associated with osteoarthritis

Weight loss in non-diabetic patients: where does semaglutide fit in?

Two AR-GLP1s (semaglutide and liraglutide) are also available for the treatment of obesity. It should be noted that the products used to treat obesity are different from those used to treat type 2 diabetes. This is due to the fact that the dose required to lower blood glucose is different from the dose needed to maximize weight loss.

The AR-GLP1s approved for the treatment of obesity are indicated for individuals with a BMI greater than 30 kg/m², or a BMI greater than 27 kg/m² who already have health problems caused by their weight (e.g., hypertension, obstructive sleep apnea). Currently, these products are not covered by public drug plans in Canada, but some private insurers may cover them.

There is limited experience with GLP1-RAs for the treatment of obesity, but there appears to be a high risk of weight regain if treatment is discontinued, especially if lifestyle habits (e.g., diet, physical activity) are not optimal. To learn more about obesity treatment options, talk to your health professional.

Your pharmacist is there to help you manage your diabetes!

If you have type 2 diabetes, it's important to optimize your treatment so that you reach your treatment targets. Well-controlled diabetes can prevent or slow the progression of complications and improve your quality of life. 

Your pharmacist is there to ensure that your treatment is appropriate and is well tolerated. In some provinces, pharmacists can adjust your medications or even prescribe treatments to help you reach your treatment targets.

They can also teach you how to use injectable medications, recommend the best device for monitoring your blood glucose levels, and support you in your efforts to improve your lifestyle habits.