Non-Insulin Injectables

Typically, when we think about injectable therapy to treat diabetes, insulin is the first medication that comes to mind. There is no doubt that insulin is an effective treatment for many people with type 2  diabetes who do not achieve adequate blood sugar control from lifestyle changes and metformin alone. There are, however, other injectable options for the treatment of type 2 diabetes that have been proven very effective in reducing HbA1c. Some of the most frequently used non-insulin injectables belong to a category of medications known as GLP-1 RA’s, also known as Glucagon-Like Peptide-1 Receptor Agonists.

This class of medications works on a hormone system in the body (known as incretins) that has been found to help lower blood sugars by increasing insulin output and suppressing glucagon secretion. Glucagon is a hormone that helps keep blood sugars elevated when necessary by increasing glucose production in the liver. In people with diabetes, this mechanism doesn’t function properly, thus causing increases in blood glucose.

These medications have been proven effective in lowering HbA1c in people with type 2 diabetes, with the added benefit of a lower risk of low blood sugars (or hypoglycemia). The newest ADA Guideline recommends the use of GLP-1 RA’s before insulin in many instances¹. Of course, in cases where blood sugars remain excessively high and people may be at risk of complications due to hyperglycemia, insulin may often be necessary. This class of medications also has the added bonus of weight loss in many instances, and if you have a history of cardiac events such as angina or stents in your coronary arteries, these medications can actually help lower your risk of additional “events” related to heart disease¹. You also may not need to check blood sugars as frequently as you do when prescribed basal insulin, due to lower risk of hypoglycemia². If you are adding one of these medications to insulin or other diabetes treatment oral medications you may be taking already, the risk for hypoglycemia can go up due to additive effects.

As with any medications there are also risks/precautions when you are taking one of the medications listed above. Some of them are as follows:

1. Stomach issues, specifically nausea and vomiting.
2. Not to be used if a person has a history of pancreatitis or certain forms of thyroid cancers (your physician will assess for this)

In addition, these newer injectables can be quite costly. Check with your pharmacy and insurance carrier for pricing information. Keep in mind that if one medication or brand is not covered, there may be other options available in this list that may be on the formulary of your insurance company that will be more cost effective. In addition, offers or coupons are sometimes available, but will not generally work for people on Medicare. In addition, check to make sure that pen needles are included with your prescription, as many times the actual pen needles require a separate prescription.