Ep 17 — GLP-1 in Type 1 Diabetes: Beyond Weight Loss | Prof Viral Shah | GNL Podcast

🎧 Episode 17 —GLP-1 in Type 1 Diabetes: Beyond Weight Loss, Towards Metabolic Therapy https://theglucoseneverlies.com/glp1-... Guest:Guest: Professor Viral Shah, MD Host: John Pemberton 📖 Summary PDF, Show Notes & Resources, & links to Podcast Providers (Apple, Spotify, BuzzSprout, and others) → https://theglucoseneverlies.com/subsc... 📺 Watch & Subscribe on YouTube → @TheGlucoseNeverLies Support The Glucose Never Lies® Podcast ☕ Support GNL via Stripe - https://Support GNL via Stripe.com/gnlfree 💙 Donate - https://www.paypal.com/ncp/payment/FG... What's covered? Insulin delivery mismatch: injected insulin goes to the periphery, not the portal vein, driving insulin resistance. Excess circulating insulin: promotes weight gain and metabolic stress. Low portal insulin → high glucagon: post-meal hyperglycaemia and increased insulin needs. Cycle of resistance: higher insulin doses → more weight gain → harder control. Further reading: Overcoming Insulin Resistance in T1D How GLP-1 Therapies Work Delay gastric emptying → reduce post-meal glucose spikes. Increase satiety → reduced food intake. Suppress glucagon → improve post-meal stability. Potentially supports residual insulin secretion. See also: Seven Ways to Combat Insulin Resistance GLP-1s in Type 2 Diabetes and Obesity Trials in type 2 diabetes show large weight loss and HbA1c improvements. Semaglutide and tirzepatide are now widely approved for T2D and obesity. Evidence base is clear: these drugs shift outcomes by 30–40%, not 5–10%. Evidence in Type 1 Diabetes Exenatide and liraglutide: early studies, modest benefit. Semaglutide trials: up to 30% insulin dose reduction, weight loss, improved time in range. Tirzepatide (observational): similar outcomes in real-world use. Consensus guidelines: co-authored by Viral Shah, outlining safe off-label use. Practical Take-Homes for People with Type 1 Diabetes Insulin reduction strategy: start low, go slow. Target ~30% reduction, but individualise. Basal vs bolus: MDI: reduce both cautiously, monitor frequently. Pump: algorithm may adapt, but still reduce manually. AID: systems adjust, but watch for early hypoglycaemia. Monitoring: Adjust based on starting HbA1c. CGM critical — link: CGM Series Nutrition: Protein ≥1.5 g/kg to preserve muscle. Pair with resistance training. Multivitamin/mineral support if appetite falls. Side effects: nausea, delayed gastric emptying, hypoglycaemia if insulin not reduced enough. Guidance for Healthcare Professionals Off-label prescribing: understand risk–benefit. Titrate slower in type 1 than type 2. Choose agent: semaglutide may carry lower hypo risk than tirzepatide. Monitor labs: LFTs, pancreatic enzymes as baseline and follow-up. Modelling long-term benefit: DCCT/EDIC legacy data shows HbA1c lowering reduces complications — GLP-1 may extend this. Future Directions Triple/quad agonists in development. Reimbursement challenges — evidence is strong but RCTs limited in T1D. Paediatric potential — currently approved in T2D from age 12, why not T1D? Evidence ADJUNCT ONE — PMID 27506222 ADJUNCT TWO — PMID 27493132 ADJUST T1D — PMID 40550013 Semaglutide Cross — PMID 39794615 Tirzepatide Obs — PMC11571402 Shah Discontinuation — PMID 39717993 Insulin Titration — PMID 39829697 Adjunct Review — PMID 40618954 Bone Review — PMC8118128 Weight Loss Bone — PMID 38916894 Consensus / Guidelines ADA Standards 2025 — PMID 39651989 ISPAD 2024 — PMID 39657603 GLP-1 AID Consensus — PMID 39517127 --- The Glucose Never Lies® | Independent diabetes education 🌐 https://theglucoseneverlies.com 🎙️ All episodes: https://theglucoseneverlies.com/gnl-p... 📊 GNL Explorers: https://theglucoseneverlies.com/gnl-g... ☕ Support the podcast: https://Support GNL via Stripe.com/gnlfree GNL Ltd — Directors: John Pemberton, Anjanee Kohli, Phil Hayes Scientific Advisers: Dr Dessi Zaharieva (Stanford), Prof Othmar Moser (Medical University of Graz), Dr Adrian Brown (UCL) Subscribe for evidence-led diabetes education — no hype, no shortcuts, just the science. --- Support GNL: https://Support GNL via Stripe.com/gnlfree The Glucose Never Lies® is a registered trademark of The GNL Ltd. Company No. 16733595. UK VAT No. GB 516 3272 08.