GLP-1 medications: what they are, who they help, and what to watch for

Nov 11

GLP-1 receptor agonists (and the newer twin-action drugs like tirzepatide) have become a major tool for treating type 2 diabetes — and some are also FDA-approved for chronic weight management. They can produce meaningful improvements in blood sugar, reduce appetite, slow gastric emptying, and — for some agents — reduce cardiovascular risk. Below I’ll explain how they work, list the commonly used medicines (injectable and oral), who might benefit, what they’re also approved to treat, the usual side effects, and rare but important safety concerns to know about. This is general information — if you’re considering one of these medications, we’ll decide together whether it’s appropriate for you based on your medical history and goals.

How GLP-1 drugs work — the basics

GLP-1 (glucagon-like peptide-1) is a hormone released in the gut after you eat. GLP-1 receptor agonists mimic that hormone and act on receptors in the pancreas and brain to:

Increase insulin secretion when blood sugar is high,
Reduce glucagon release (which lowers blood sugar),
Slow stomach emptying (which decreases appetite and helps with weight loss),
Reduce appetite through effects on brain appetite centers.

Some newer drugs (e.g., tirzepatide) act on both GLP-1 and other gut hormone receptors (GIP), which can produce even larger weight loss and glucose-lowering effects.

Popular GLP-1 and GLP-1–type medications (quick reference)

Injectable GLP-1s commonly used in the U.S.:

Semaglutide — available as Ozempic (weekly injection for type 2 diabetes) and Wegovy (weekly injection specifically FDA-approved for chronic weight management). FDA Access Data
Tirzepatide — Mounjaro for type 2 diabetes (weekly injection). A tirzepatide brand Zepbound is FDA-approved specifically for chronic weight management. U.S. Food and Drug Administration
Dulaglutide — Trulicity (weekly injection for type 2 diabetes; has evidence for cardiovascular benefit in people with diabetes). FDA Access Data
Liraglutide — Victoza (daily injection for type 2 diabetes) and Saxenda (higher-dose liraglutide for weight management). FDA Access Data

Oral option:

Oral semaglutide — Rybelsus (daily tablet) — approved for improving glycemic control in adults with type 2 diabetes. It offers an alternative for patients who prefer a pill instead of injections. FDA Access Data

Different brand names can contain the same active drug at different doses and for different indications — e.g., semaglutide appears in Ozempic, Wegovy, and Rybelsus but with different dosing and approved uses. Always check which brand and dose you’re being prescribed. NCBI

Who might be a good candidate?

These are common scenarios where a GLP-1 or tirzepatide-type therapy may be appropriate:

People with type 2 diabetes who need better blood-sugar control and may benefit from weight loss or lower risk of cardiovascular events (choice depends on individual cardiovascular risk and comorbidities).
Adults with obesity (or overweight with related conditions) who meet FDA criteria for chronic weight-management medications (e.g., BMI thresholds plus related conditions) and for whom lifestyle measures alone haven’t produced desired results. Some agents are specifically labeled for weight management (Wegovy, Zepbound, Saxenda). FDA Access Data+2U.S. Food and Drug Administration+2
Patients who want to avoid hypoglycemia and weight gain sometimes seen with older diabetes drugs — GLP-1s lower glucose in a glucose-dependent way and are weight-neutral to weight-reducing rather than causing weight gain.

Not every patient is a candidate — people who are pregnant or planning pregnancy, those with certain thyroid cancer histories, and people with some gastrointestinal conditions may need alternative options (more on that below).

Other FDA-approved benefits beyond glucose lowering

Weight management: Wegovy (semaglutide) and Zepbound (tirzepatide) are FDA-approved for chronic weight management in appropriate adults. Saxenda (liraglutide at higher dose) is another approved weight-loss injection. FDA Access Data+2U.S. Food and Drug Administration+2
Cardiovascular outcomes: Some GLP-1s have been shown to reduce major cardiovascular events in people with type 2 diabetes and established cardiovascular disease; semaglutide has data supporting cardiovascular benefit in certain populations. These differences influence which agent a clinician might choose. American College of Cardiology

Common side effects (what most people experience)

The majority of side effects are gastrointestinal and dose-related:

Nausea, vomiting, and early satiety (feeling full quickly) — often improve over weeks as the dose is titrated slowly.
Diarrhea or constipation.
Abdominal pain and bloating.
Some people experience injection-site reactions (for injectables).
Most of these are manageable with gradual dose increases, adjusting meal composition, and supportive measures. If GI side effects are severe or persistent, we may stop the medication or switch to a different agent.

Rare but important safety concerns and long-term risks

These are uncommon but critical to consider:

Thyroid C-cell tumors / medullary thyroid carcinoma (MTC) — Certain GLP-1 drugs (notably liraglutide and semaglutide labels) include boxed warnings or warnings because rodent studies showed thyroid C-cell tumors. Because of those findings, these drugs are contraindicated in people with a personal or family history of medullary thyroid carcinoma or with Multiple Endocrine Neoplasia type 2 (MEN 2). The human relevance is uncertain, but the warnings and precautions remain in prescribing information. FDA Access Data+1
Pancreatitis and biliary disease — Cases of acute pancreatitis have been reported with GLP-1 class drugs; gallbladder disease (cholelithiasis/cholecystitis) appears more common with substantial weight loss and with these agents in clinical trials. If you have a history of pancreatitis or gallbladder disease we’ll discuss risks carefully. PMC+1
Gastrointestinal obstruction / severe GI adverse events — There have been reports of severe GI events (including small-bowel obstruction and gastroparesis-like symptoms) especially in some patients using these drugs for weight loss; these are uncommon but can be serious. (Ongoing monitoring and prompt reporting of severe abdominal symptoms is important.)
Hypoglycemia when combined with other glucose-lowering agents — GLP-1s by themselves cause low risk of hypoglycemia, but when used with insulin or sulfonylureas the risk of low blood sugar rises — dose adjustments are often needed.
Unknown long-term effects — These are relatively new widespread therapies for weight management; researchers are continuing to study long-term effects (positive and negative). We will weigh what we know now against your personal health goals and history.

(These safety points are based on current prescribing information and cardiovascular outcome trial findings.) FDA Access Data+1

Practical considerations & monitoring

Start low, go slow. Most GLP-1 regimens use gradual dose escalation to improve tolerability.
Baseline tests. Before starting we usually review your medical history, current medications, pregnancy plans, and baseline labs (A1c, kidney function, sometimes baseline lipids).
Watch for warning symptoms. Seek urgent care if you have severe abdominal pain (possible pancreatitis), persistent vomiting/diarrhea causing dehydration, or signs of thyroid problems (neck mass, hoarseness, difficulty swallowing).
Pregnancy and breastfeeding. These medications are generally not recommended during pregnancy; if you plan to conceive, we will discuss stopping the medication and safer alternatives.
Insurance and cost. Coverage varies widely — Wegovy, Zepbound, and others can be expensive without insurance coverage for weight management. We can discuss benefits, alternatives, and potential financial resources.

Bottom line — is a GLP-1 right for you?

GLP-1 and related agents are powerful tools for treating type 2 diabetes and (for specific drugs) chronic weight management. They can improve blood sugar, help with weight loss, and in some cases reduce cardiovascular risk. But they’re not right for everyone — contraindications (e.g., personal/family history of MTC or MEN 2), pregnancy plans, prior pancreatitis, or intolerable GI side effects could steer us toward other options.

If you’re curious about whether one of these medicines might help you — for diabetes control, weight-management, or reducing cardiovascular risk — schedule an appointment at Homestead Direct Primary Care. We’ll review your medical history, discuss realistic benefits and risks for your situation, and if appropriate start a safe, monitored plan with close follow-up.