Do GLP-1s and SGLT2s Affect Insulin Use, and Do They Cause Hypoglycemia?

Dear Dr. Edelman,

If you take GLP-1s or SGLT2s, do you use less insulin? And can they cause hypoglycemia?

Dr. Edelman: The SGLT2 and the GLP-1 medications have a lot of great benefits – they’re good for the heart and the kidneys, they can help you lose weight, and they lower blood sugars. But they do not on their own cause hypoglycemia or low blood sugar. Based on how they work, they do not lower your blood sugar levels below the normal levels of people without diabetes, so they do not cause low blood sugars or hypoglycemia by themselves.

However, if you’re taking another medication like insulin that can cause low blood sugars, or if you’re on a sulfonylurea such as Glucotrol, Glyburide, or Amyrl, those medications can cause low blood sugars. So if you add anything to them that makes your blood glucose control better, you can experience hypoglycemia.

In general, if you’re starting off with pretty good blood sugar control – let’s say with insulin – and you add an SGLT2, GLP-1, or sulfonylurea, then you’re probably going to want to reduce your insulin doses a little bit. Always discuss these adjustments with your healthcare professional.

If your blood sugar control is not where you want it to be and you’re taking insulin, a sulfonylurea or another medication, and you add a GLP-1 or SGLT2, then it might bring you down to the right place.

To recap, GLP-1s and SGLT2s don’t cause lows, but they certainly can contribute to low blood sugars caused by other medications. Remember to always check with your doctor before adjusting any medication dose!

  1. Avatar

    I was recently diagnosed with pigmentary glaucoma which is associated with activity. I run 5 times per week and I ride my bike 50 miles at least one time per week. I have type 1 diabetes.

    My eye doctor told me not to stop exercising. However, exercise can supposedly make it worse. What are your thoughts on this? I cannot find a lot of literature on this.

    If I keep exercising, will this make me go blind? If I don’t exercise, how do I keep my glucose in control as a type 1 diabetic. I am 61 years old and was diagnosed with type 1 at age 32.

    Thank you for any thoughts/suggestions

    • I am not an expert in that eye condition. However, I empathize with you, and would feel the same if someone told me I could not exercise. I would seek two or three opinions from super specialists in this area.

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