Exploring Type 2 Diabetes Medications for People with Type 1 Diabetes‍

Editor’s note: This article is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional before making any changes to your diabetes management plan, including the use of medications intended for type 2 diabetes. 

While nothing can replace our daily need for insulin, these medications are proving in research and real-world management to be very helpful in T1D. Here’s a closer look at how these medications work and their potential advantages for people with type 1 diabetes.

1. Metformin: The First Oral Diabetes Medication

Metformin is one of the most well-known type 2 diabetes medications — it’s been considered the “first line of defense” for decades. The drug works by reducing the amount of glucose your liver produces, and it improves your overall insulin sensitivity. The result is that you need less insulin, and your cells can use insulin more effectively. 

Metformin also reduces how much sugar you absorb from the food you eat! Sort of like a “carb blocker, " meaning some carbohydrates in your meal don’t affect your blood sugar. This further decreases the amount of insulin you need with meals.

While people with T1D don’t produce much or any insulin, metformin can still have a noticeable impact on blood sugar levels and daily insulin doses. 

For people with T1D, metformin may help by:

• Increase insulin sensitivity
• Decrease basal and bolus insulin doses
• Supports weight-loss goals

My experience with metformin and T1D: I’ve been taking it for a while to manage dawn phenomenon! I take 1000 mg every night before bed to calm my liver’s glucose production down at the same time dawn phenomenon would normally be triggering my liver to release glucose.

Other things to know about metformin:

• It’s pretty affordable, especially compared to other modern diabetes medications. Especially in the generic form, metformin is very inexpensive.
• It’s hit or miss with the side effects. Some people tolerate it really well, and others experience significant diarrhea. Taking the “extended-release” form of metformin lessens side effects.
• It doesn’t cause low blood sugar on its own, but it will affect your insulin doses. You may need to significantly reduce your basal and bolus insulin doses as soon as you start taking metformin regularly. Talk to your doctor for support.
• It’s pretty easy to get insurance coverage for — even with T1D. If your doctor conveys in your prescription that you’re struggling with insulin resistance and post-meal spikes in your blood sugar, it’s generally pretty easy to get it covered by insurance.

Take a peek at this research from Harvard calling metformin the “fountain of youth” and its benefits related to other health conditions.

2. SGLT-2 Inhibitors: Filtering Sugar Out Through Your Kidneys

SGLT-2 inhibitors, such as empagliflozin (Jardiance) and dapagliflozin (Farxiga), work by preventing the kidneys from reabsorbing glucose, causing excess sugar to be excreted through urine.

Sounds pretty cool, right?

It is, but it’s complicated, too. Actually, despite sounding like a simple oral medication, this one can be a little dangerous for people with T1D. I know some people who’ve had a great experience with it and others who’ve really struggled with side effects.

Potential benefits for people with type 1 diabetes include:

• Lowering blood sugar levels
• Reducing insulin requirements
• Supporting weight loss
• Providing heart and kidney protection

My experience with an SGLT-2 and T1D: I tried taking an SGLT-2 for one week, and I couldn’t stand it. I was so thirsty, and it’s very important to drink a lot of water when taking an SGLT-2 because your kidneys are working hard to filter that extra glucose.

This means you can become easily dehydrated if you don’t take your water consumption very seriously. Like, every day, lots of water.

Other things to know about SGLT-2 medications:

• In people with T1D, SGLT-2 inhibitors come with a significant risk of diabetic ketoacidosis (DKA) — even when blood sugar levels aren’t extremely high, especially if you’re on a low-carb diet. 
• Research says SGLT-2s can significantly help people with kidney disease, protecting kidney function—something to consider if you have been diagnosed with any stage of diabetic kidney disease.
• Women taking an SGLT-2 may experience yeast infections very easily because the extra sugar filtered by their kidneys through their urine can feed the growth of yeast in their urinary tract. Not fun!

SGLT-2s are super cool, but they are really a hit-or-miss on who appreciates the benefits simply because of the side effects.

3. GLP-1 & GIP/GLP-1 Receptor Agonists: The Trendiest of Them All

GLP-1 and GIP/GLP-1 receptor agonists, like semaglutide (Ozempic) and tirzepatide (Mounjaro) mimic natural hormones that help manage blood sugar, appetite, digestion, and more. 

While you’ve likely heard about these medications in the media for the benefits they offer people with type 2 diabetes and/or obesity, they can have a big impact on T1D, too.

Remember those five hormones you don’t produce normal amounts of with T1D? Medications like Ozempic and Mounjaro can help people with T1D compensate for the lack of those hormones. 

Potential benefits for people with type 1 include:

• Delayed digestion = easier post-meal blood sugar management: This helps prevent post-meal spikes in your blood sugar and keeps you feeling full longer.
• Reducing your appetite & feeling full sooner: It’s not just a full stomach that keeps you feeling full; it’s also signals to your brain that regulate appetite! That constant T1D hunger is not “all in your head” — it’s directly related to your body’s lack of hormones and signaling to the brain when you’re eating.
• Reducing liver glucose production affects overall insulin needs: Yup, just like metformin, these medications can significantly calm down glucose production in the liver. This can mean you need less basal/background insulin.
• Weight loss: Well, all of the above contributes to weight loss, which means you become more sensitive to insulin, which furthers weight loss, and so on. If you’re struggling to budge the scale with T1D, you’re not alone. Losing weight with T1D is challenging. These medications can help.

While GLP-1 receptor agonists are not officially approved for us in T1D, many doctors prescribe them off-label. Getting insurance to pay for it really comes down to your doctor and how they write the prescription. They definitely have to be creative in how they express and describe insulin resistance and post-meal blood sugar spikes to get that insurance approval.

My experience taking a GLP-1 medication: I’ve been taking a microdose of Ozempic for a couple of years, and it is so helpful. While I wasn’t looking to lose weight, it does help me maintain my current weight with far less effort. It also increased my insulin sensitivity and makes it easier overall to stay in my target range. 

I also deeply appreciate the impact it has had on my appetite. I’d gotten very good at ignoring the constant hunger that can accompany T1D, but it is exhausting, too! Learn more about my GLP-1 experience over here: DiabetesNerd.

Other things to know about GLP-1 medications:

• Side effects: Yes, the side effects can include nausea and vomiting…if you’re taking too much! If you take a reasonable dose and listen to your body, you can get the benefits without feeling constantly sick. 
• Combine with lifestyle changes for best benefits: To get the most benefit, GLP-1 medications should absolutely be combined with regular exercise and a diet full of mostly whole foods. Today, I take a tiny dose, only 0.15 mcg, which is so helpful.
• Your doctor may say no: Many doctors still don’t understand or believe how helpful these medications are for people with T1D. I highly recommend working with virtual diabetes nurse practitioner Chris Szoke if you need help getting insurance approval!
• Consider it a long-term medication: Don’t start taking a GLP-1 medication unless you intend to stick to it long-term. Within weeks of stopping these medications, your liver glucose production goes up, your appetite increases etc., and you lose the benefits. This can lead to rapid weight gain and blood sugar frustration. 

Many people describe GLP-1 and GIP-GLP-1 medications as “game-changers” in type 1 diabetes management. I’m one of them! It just makes everything feel a little easier and a little more normal. 

Talk to Your Healthcare Team

It really comes down to your healthcare team and how up-to-date they are on the benefits of these medications in T1D. Many people with T1D take medications intended for T2D, but it truly starts with finding a doctor or nurse practitioner who understands the benefits and how to prescribe the medication to get it covered by your insurance successfully.