- GLP-1 medications aren’t FDA-approved for type 1 diabetes, but many people are using them off-label with positive results.
- GLP-1s do more than promote weight loss. They can improve insulin sensitivity, reduce insulin needs, quiet “food noise,” and help protect against heart, kidney, and liver disease.
- Years ago, there were concerns that people with type 1 might be at higher risk for hypoglycemia and DKA, but today’s GLP-1s are more advanced. With careful insulin dose adjustments, the risks can be minimized.
- A large clinical trial called SURPASS-T1D-1 is examining tirzepatide (the ingredient in Mounjaro and Zepbound) in adults with type 1 diabetes who also have overweight or obesity.
- If the SURPASS-T1D-1 trial is successful and an application is submitted to the FDA early next year, GLP-1s could be approved for type 1 diabetes by the end of 2027.
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Remember being a kid on a summer road trip? Every 15 minutes you’d yell from the back seat, “Are we there yet?” Eventually your parents would threaten to turn the car around, but that wouldn’t stop you from asking again five minutes later.
That’s what it feels like for a lot of people with type 1 diabetes when it comes to the approval of GLP-1 medications. Whenever there’s a splashy headline touting a new benefit of GLP-1s for type 2 diabetes, or someone posts a success story on social media about their results from Ozempic or Mounjaro, we can’t help but wonder, “When will there be a GLP-1 for type 1 diabetes? Are we there yet??”
The reality is that we’ve still got a ways to go, but for the first time in a long time, we’re getting closer.
Here’s where things stand.
GLP-1s: Quick Facts
GLP-1 stands for “glucagon-like peptide-1”, which is a hormone your intestines naturally release after you eat.
GLP-1 medications mimic this hormone and help:
- Slow stomach emptying so food is absorbed more gradually
- Reduce appetite and increase feelings of fullness (satiety)
- Lower glucagon (a hormone that raises blood sugar)
- Improve insulin resistance
In people with type 2 diabetes, these medications also stimulate the pancreas to release more insulin. Of course, in type 1 diabetes, the insulin-producing beta cells have been destroyed, so that particular benefit doesn’t apply. But the others do.
Even though some GLP-1 medications contain the same active ingredient (for example, Ozempic and Wegovy are both semaglutide, and Mounjaro and Zepbound are both tirzepatide, which activates both the GLP-1 and GIP receptors), they’re approved for different uses and marketed under different names.
Ozempic, Mounjaro, and Trulicity are for type 2 diabetes, while Wegovy, Zepbound, and Foundayo are FDA-approved for weight management.
A GLP-1 for Type 1 Diabetes: Why Isn’t It Approved Yet?
A few reasons.
Clinical trials and GLP-1 studies are massive undertakings that can take years to complete, and they can cost hundreds of millions of dollars. Pharmaceutical companies likely focused on type 2 diabetes initially because so many more people have T2D (nearly 40 million in the U.S, with less than 3 million people with T1D), and the path to approval was more straightforward.
Years ago, there were also concerns that people with type 1 diabetes might be at higher risk for hypoglycemia and DKA with GLP-1s.
But things have changed. Today’s GLP-1 medications are more advanced than earlier versions, and CGMs and AID systems are helping people manage diabetes better than ever. As a result, researchers are seriously studying GLP-1s for T1D.
A large Phase 3 clinical trial from Lilly called SURPASS-T1D-1 is examining tirzepatide (the ingredient in Mounjaro and Zepbound) in adults with type 1 diabetes who also have overweight or obesity. The trial is expected to wrap up by the end of this year.
The Benefits of GLP-1s
GLP-1s are most known for weight loss, but that’s only the tip of the iceberg. Here are some of the top reasons we’re excited about GLP-1s for type 1 diabetes:
Weight Loss
Believe it or not, about half of people with type 1 diabetes are overweight (overweight is having a BMI between 25-29.9 and obese is having a BMI of 30 or more), and it’s not always about willpower. Insulin is a storage hormone, and exogenous insulin can make losing weight a little harder.
- Lower Insulin Needs
Many people find that as they lose weight and become more insulin sensitive, they need less insulin throughout the day. This can mean less weight gain, lower insulin requirements, and reduced insulin resistance.
- Less “Food Noise”
Many people say they spend less time thinking about their next meal, have fewer food cravings, and find emotional eating easier to control.
- Protection for Your Heart, Kidney, and Liver
Several GLP-1 medications have been shown to reduce cardiovascular risk, slow kidney disease progression, improve liver disease (MASLD/MASH), and reduce chronic inflammation.
- Better Sleep
Sleep apnea is more common in type 1 diabetes than many people realize. Zepbound is the only FDA-approved GLP-1 to treat sleep apnea, but other GLP-1s likely offer similar benefits.
Are GLP-1s Safe for People with Type 1 Diabetes?
When it comes to type 1 diabetes and GLP-1s, the biggest question isn’t whether they work – it’s whether they can be used safely.
Fortunately, a growing body of research now supports the safety of GLP-1s in people with type 1.
A study led by researchers at the Johns Hopkins Bloomberg School of Public Health found that people with type 1 diabetes who took GLP-1 medications for weight loss or improved glucose control had lower risks of major cardiovascular events and end-stage kidney disease, without an increase in safety concerns.
The American Diabetes Association also officially recommends considering GLP-1 medications for people with type 1 diabetes who have overweight or obesity when it’s clinically appropriate.
In addition, an expert consensus report has been published to help healthcare providers prescribe and manage these medications in people with T1D.
The main safety concern isn’t the medication itself – it’s adjusting insulin incorrectly after starting it.
Because GLP-1s reduce appetite and slow stomach emptying, you’ll likely eat less and need less insulin, which raises the risk for hypoglycemia if not adjusted properly.
If insulin doses are reduced too much, the risk of diabetic ketoacidosis (DKA) can increase.
If you decide to start a GLP-1, make sure to work closely with your healthcare team to adjust your insulin doses appropriately.
Who Is Most Likely to Benefit from a GLP-1?
GLP-1s aren’t right for everyone with type 1 diabetes, but for some people they can be game changers.
Many experts feel that the mechanism of action of the following benefits will be similar in type 1 as they are in type 2, though not all have been proven in type 1 yet.
You might benefit if:
- You have overweight or obesity: GLP-1s can reduce appetite, help you feel full sooner, and make it easier to lose weight.
- You have insulin resistance: GLP-1s can support weight loss and improve your body’s response to insulin.
- You struggle with post-meal glucose spikes: GLP-1s slow gastric emptying and blunt the glucagon response after meals, which can smooth out post-meal spikes.
- You have cardiovascular risk factors: Certain GLP-1s have been shown to reduce the risk of cardiovascular events in people with type 2 diabetes, and these benefits may extend to those with type 1 as well.
- You have kidney disease: Several GLP-1 medications have been shown to slow the progression of chronic kidney disease.
- You have sleep apnea: Zepbound is officially approved for sleep apnea.
- You have fatty liver disease: Several GLP-1s have been shown to reduce liver scarring.
Many people with type 1 diabetes check several (if not all) of these boxes, which is why there’s so much interest in the diabetes community (including healthcare providers) about having an FDA-approved GLP-1 for T1D.
Who Might Not Be a Good Candidate for a GLP-1?
For some people, the risks may outweigh the benefits. Talk with your doctor about the pros and cons if any of these apply to you:
- You’re currently at a healthy weight, or underweight: If weight loss isn’t a goal, the appetite-suppressing effects of GLP-1s may not be what you’re looking for. However, there are ways to mitigate weight loss while taking a GLP-1.
- You have severe gastroparesis: GLP-1s can worsen symptoms of gastroparesis for some people, and they aren’t recommended for those with severe gastroparesis.
- You’ve had pancreatitis or have certain endocrine conditions: People with a history of pancreatitis or a personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) generally should not take GLP-1s.
- You’re looking for a “magic fix”: GLP-1s work best when they’re part of a plan that includes healthy eating, regular physical activity, and good diabetes management.
Let’s Talk Side Effects
Not everyone experiences side effects with GLP-1s, and many people only have mild symptoms. Symptoms are usually the strongest the first few weeks after starting treatment, and after increasing a dose.
Common side effects include:
- Nausea
- Vomiting
- Constipation
- Diarrhea
- Heartburn
- Feeling overly full (like after a big Thanksgiving dinner!)
Fortunately for most people, symptoms generally improve over time. The key is to not rush it…start with the lowest dose possible, and don’t go up to the next dose if you’re still experiencing symptoms.
A few additional tips:
- Eat smaller, more frequent meals
- Stop eating when you feel full
- Limit high-fat foods and greasy foods
- Stay hydrated
If side effects become severe or do not improve after a few weeks, reach out to your healthcare provider.
A Note about Muscle Mass
While GLP-1s help you lose body fat, you’ll also lose some lean muscle mass along the way. Lifting weights or doing other resistance exercises can help preserve the muscle mass you have, and even help you build more.
This can happen with virtually any type of significant weight loss, not just with GLP-1s. Whether you lose weight through diet, bariatric surgery, or medication, some muscle mass loss is expected.
How to Shirk the System and Get a GLP-1 Right Now
Many doctors prescribe GLP-1 medications off-label, which means they prescribe it for a condition other than the one it was officially FDA-approved to treat. It happens all the time and is totally legal, so don’t worry that the GLP-1 police are going to come knocking on your door.
However, you still have to get your insurance company to pay for it.
Your doctor will need to submit a prior authorization showing that you have a valid reason for taking the medication.
For GLP-1s, that might include:
- Obesity-Related Complications and/or Cardiovascular Risk factors: If your BMI is 27 or higher and you have at least one weight-related condition (such as high blood pressure or high cholesterol), you may qualify for Wegovy or Zepbound. If your BMI is 30 or higher, you may qualify based on weight alone. Also, diabetes is considered a cardiovascular risk factor, as is a family history of heart disease.
- Obstructive Sleep Apnea: If you have obesity and sleep apnea, you may qualify for Zepbound.
The prior auth should not mention that you have diabetes – it should talk about obesity. But if the authorization gets denied because the insurance company looked at prior notes that mention that you have type 1 diabetes, you can go back to them with an appeal stating that type 2 diabetes runs in your family and you have significant insulin resistance and/or metabolic syndrome, or “double diabetes“.
If you have chronic kidney disease or fatty liver disease, your doctor should include them in the prior auth as well – it may help your odds for approval.
GLP-1s for Type 1 Diabetes: Frequently Asked Questions
💉 Can type 1 diabetics take Ozempic for weight loss?
Ozempic is officially indicated as a type 2 diabetes medication. If you have type 1 diabetes and you are interested in taking semaglutide, your doctor would need to prescribe Wegovy for weight loss, primarily for insurance purposes.
💪 What if you don’t want to lose weight?
If you want the GLP-1 benefits but don’t need or want to lose weight, you can start at the very lowest dose possible, and titrate up slowly to the dose that gives you the most benefit but keeps you at the weight you’re comfortable with. You don’t have to be on a super high dose in order for the medication to be effective. You also might want to work with a dietitian to make sure you’re eating enough calories and protein to maintain your weight and muscle mass.
👎 What are the downsides of GLP-1s?
You may have seen articles or social media posts that raise concerns about GLP-1 medications. While no medication is right for everyone, my experience treating hundreds of patients—and hearing the latest research presented by diabetes experts at medical conferences—is that GLP-1s are generally very well tolerated. The most common side effects are nausea and other gastrointestinal symptoms, especially when you first start the medication or increase the dose. That’s why it’s important to start low and go slow. Ultimately, the decision to start a GLP-1 should be made in partnership with your doctor, who can help weigh the potential benefits and risks based on your personal health history.
🤔 What if my gastroparesis isn’t that bad?
If your gastroparesis symptoms are mild, a GLP-1 medication may not necessarily make them worse. In fact, some people find that eating smaller meals (which often happens naturally while taking a GLP-1) can reduce symptoms like feeling overly full or bloated. That said, GLP-1s slow stomach emptying, so they aren’t the right choice for everyone. It will depend on how severe your symptoms are, how well your stomach is functioning, and whether the potential benefits outweigh the risks. This is definitely a conversation to have with your healthcare provider before starting a GLP-1.
📆 Do I have to stay on this medication long term?
Yes – this should be lifelong therapy! If you just want to lose 10 pounds before your son’s wedding, these probably aren’t the right medications for you. GLP-1s are designed to treat a chronic condition, not provide a quick fix. When most people stop taking them, they gain any weight they’ve lost back, and they also lose many of the extra benefits these medications provide. If you’re not tolerating the medication or can’t continue it for another reason, that’s a different story. But these meds are meant to be taken long-term.
GLP-1s and Type 1 Diabetes Takeaways: So How Close Are We?
The data we’ve seen so far about the benefits of GLP-1s for people with type 1 diabetes has been encouraging, but inquiring minds still want to know…when will they actually be approved??
If Lilly’s SURPASS-T1D-1 trial is successful and an application is submitted to the FDA early next year, GLP-1s for type 1s could be approved by the end of 2027.
Until then, they’ll remain an individual option off-label.
Thankfully, research is moving forward and “Are we there yet?” doesn’t seem like such an impossible question to ask. We don’t know exactly when we’ll get there, but at least for now, the road signs are pointing in the right direction.
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What about my obese friend who is already on dialysis? Is there any evidence about the safety of GLP-1s in his case?
Generally speaking there’s no reason why it could not be helpful, but his doctor would need to review his medical history to see if there are any contraindications.
What about long term use?
It’s crazy-I was covered initially, but no longer qualified as weight was lost. So now paying out of pocket to keep stable weight (on a low dose of GLP-1 -still expensive), less insulin resistance and other benefits listed. I just want to maintain the good.
I had a similar experience when the first CGM’s started – only qualified if you had low BG’s which I initially had but then when the CGM worked I had to make myself get 3 low’s in a week (I think it was below 55) to get coverage which was not a pleasant experience and made no sense.
Generally speaking, long term use is no issue. I think you are smart by doing everything you can to stay on a GLP-1, because the benefits are so important. And I would keep looking for cheaper sources, including Mexico and Canada, where you get the actual medication made by Lily and Novo. Medicare will also help as well if you are on Medicare. I would say you’re very smart for trying to stay on it. Good luck.
I’m just starting a GLP-1. As a T1D after starting whatever my doc decides is the maintenance dose, when should the effects become consistent? Will I always see a little more insulin used in my pump data a day or two before and after the next dose?
The effects will be consistent after a few weeks, but, as you noticed, it’s not a flat consistency. You have a peak effect, and then it wanes before the next injection.
Regarding seeing a little more insulin used in your pump data a day or two before and after the next dose, it will probably stay like that. That’s a very important observation.
Can you talk about childhood obesity and when this will be approved for younger kids.
The approval is most likely coming sooner than many people think. The study that Lily’s doing with tirzepatide is for adults only, but once it’s approved in adults, it gives pediatricians a little more leeway to use it in younger kids. So, hang in there. Keep asking your doctor about it, and you will hopefully be able to get your hands on it relatively soon after it’s approved.
The problem for me with the low dose off insurance product is that I have to use my own hypodermic needle which is crazy hard for me plus the requirement to have to keep it refrigerated.
What is the lowest dose you can dial in on a glp1 pen? Thank you
The dose could be very low. You can count the number clicks between 0 and 2.5 mg (or whatever the lowest dose is), and then you can dial a percentage of those clicks. So for example, if it takes 40 clicks to get to the first dose, you can start at 10 or 20 clicks (1/4 or 1/2 the dose). Obviously you need to talk to your doctor before adjusting any medication on your own, but that’s the general idea.