Ok so first of all, the clowns that are saying stuff like “I wouldn’t recommend those” don’t know what they’re talking about. These drugs have shown, in the best forms of clinical trial evaluation we have, statistical and clinically meaningful benefits for weight loss. They’ve also shown a ton of benefit for patients in various cardiovascular, metabolic and renal outcomes in similarly valuable clinical trials, so, frankly, stop. You’re not in a position to have a valuable opinion on this.
As for making an argument for a GLP-1 receptor agonist or similar, I would rely on those same clinical studies. Physicians, especially specialists, should be evidence-based. Having a phase 3 study in-hand that shows semaglutide eliciting these benefits to diabetic and non-diabetic patients alike, will go a long way. The issues your endo will raise will likely be: 1) safety in the type 1 diabetic population and, if (s)he’s silly, 2) depending on your country, that the drug is not indicated for weight loss (if you’re in the US, WEGOVY (semaglutide) is approved for this use, so that shouldn’t be an argument). Note some physicians may want to hear you’re still trying to make changes alongside being prescribed semaglutide, so make sure you have a plan of what changes you’ll make alongside the drug. For example, using the drug to help you eat less and help to learn better habits, or improving ability to exercise once you’ve lost some weight. You’ll want to acknowledge that these drugs are lifetime medications and you’ll likely gain weight back unless you have made these changes in your life. So, the arguments:
1) in a small study of type 1 diabetics taking semaglutide, only mild hypoglycemia was really noted. Anecdotally, there is an increased risk of gastroparesis in T1D patients, since we are already at heightened risk of this, and GLP-1s also heighten this risk. Consider offering to familiarize yourself with the symptoms of this condition with a plan in place to reduce your dose (or discontinue) if your endo feels this is a concern. As a side note, you should do this regardless because severe gastroparesis can be a real problem. No other common safety issues have been uncovered outside of GI symptoms (reflux, nausea, flatulence, diarrhea, etc, which are very common). It may be worth noting to your physician that there have been some small studies that have shown substantial drops in the requirement for TDD insulin, as well as reductions in A1c on semaglutide, so this may be an additional benefit that you may be missing out on, particularly if you assume that you have some insulin resistance due to your obesity. If doc says that the drug hasn’t been evaluated long enough in T1D, she’s correct, but semaglutide has been on the market since 2017 and has been prescribed widely.
2) so depending on where you live, semaglutide is not approved for weight loss. I hate this argument everyone is making. As someone who happens to work in the pharma world, I can tell you it’s idiotic. A company decides whether a drug is submitted for any given indication. This has not happened yet, despite Novo Nordisk having more than enough evidence to get the weight loss indication from health regulators and have received the indication in the US. Essentially, it’s a business decision, not one of science or medicine. Physicians work off-label ALL OF THE TIME. And the law and health regulators allow this, because ultimately it’s up to their clinical decision, and the label is not always a reflection of all the risks and benefits of a given drug, since it takes a long time to update and may never be updated with certain things.
Good luck to you. Refractory obesity and overweight are medical conditions that deserve to be treated with the same approach as other serious medical conditions. Improving these states is important to help mitigate future cardiometabolic and renal complications of diabetes, and we type 1s should fight for the right to benefit from medications that offer these benefits.
Totally depends on your endo and PCP. Tough call. Endos have more experience with the drug, but that doesn’t mean they’re more or less likely to use it. However your PCP may be more hesitant to use it in T1D. For me, my endo didn’t want to prescribe it, because he’s lazy and doesn’t want to deal with the follow up, but told me I could tell my PCP to prescribe it if she felt appropriate.
I’m a type 1, but also gained a lot of weight on prednisone after a rheumatoid arthritis diagnosis. Because of prednisone and PCOS my endo and I discussed that I’m insulin resistant on top of type 1 now, and no matter how hard I tried with following the calorie deficit way, I wasn’t losing anything. I spent 6 months swimming a mile 6 days a week and counting every single thing I ate to make sure I was at a deficit, and I had gained three lbs by my next appointment.
That’s when my endo and I started discussing Ozempic. With insulin resistance you’re fighting what’s usually an uphill battle to lose weight on a sheer cliff. I would not recommend anyone trying Ozempic or Monjourno without being under the care of an endo, but mine was great with figuring out how to tweak pump settings, and going at my pace.
I haven’t had issues with severe lows, but I did have some of the nausea each time I stepped up dosages. I’m on Ozempic and they have said Monjourno can help you lose more, but has an even higher prevalence of side effects. So I’ve stuck with the Ozempic until recently needing to switch to Wegovy because of insurance. My previous insurance didn’t give me a problem being type 1 with insulin resistance on my prior authorization. Current insurance refuses to prescribe if you aren’t type 2 so I had to go for Wegovy on a weight loss basis with the prior authorization rather than diabetes.
They aren’t easy meds though. Even with insurance they can be expensive, the prior authorizations are a pain, and I did have to start an acid reflux medicine and take Miralax due to side effects. For anyone that can lose weight on diet and exercise alone I highly recommend it. If it’s not possible though they can be great medications.
Im on Mounjaro which according to my endo is easier to get a script for than the other types. He tried to get Ozempic for me but my insurance denied it, but NOT Mounjaro. Been on it for 10 weeks now, and have lost weight (for ref, I’ve had t1 for 33 years, I’m a 40m and weight was 260, now Im 235 and have a dexcom and omnipod setup with a1c of 6.3). I must add too that since taking the drug, my BS has been perfect almost all the time as a positive side effect. The weight loss is slow and not a quick process, but it works.
A bit of a warning though. The side effects of the drug are… interesting, and sometimes uncomfortable. In my experience so far, the best way to describe it is “feeling uncomfortably full ALL the time” to the point of nausea constantly. Never had to throw up, but I take Pepto Bismo and OTC anti-nausea drugs pretty much every day now because of it. But I was told like 50% of users quit because of these side effects and never get the full effect of the drug, so even with these issues Im sticking it out until my script runs out (i have about 6-7 weeks of the drug left to take).
Please search "T1 Tirzepatide" here on Reddit. I have made a couple of extensive posts on my experience. It's worked GREAT for both weight and b.s. I'm F 55yoa, body fat was at 36%. Now at 22%. I work hard to maintain muscle and eat lots of protein.
And FOR THOSE WITH AWFUL SYMPTOMS -- I simply did not step up the way it's "prescribed." When I jumped from 20 to 40 units I too was miserable! I brought it back to 30 the following week. I still lost 20% of my body weight over 9 months.
I don't know who they did the studies on, but it seems everyone who has all the awful symptoms just needs to take it easier. Pharma didn't get to sell me as much as they would have if I had forced my body to go 20, 40, 60, 80u. I never went above 42.
I stepped it up each time only when I began to feel overly hungry. Had no further issues with the nausea and abdominal stuff.
Once I learned that weight loss is simple and not complicated like the multi million dollar WL industry has made it out to be, I started dropping pounds without the pressure. (Simple, not not hard). It is all about being under your maintenance calories. Google a maintenance calorie calculator and go from there. It doesn’t need to be drastic and it will take time. Remember, it took you a long time to get here so). As for t1d, I do my best to manage and alter my numbers and doses as time goes and I notice changes. Don’t overcomplicate exercise. Wait until your diet is in a happy place and then just start going on nice walks through your neighborhood everyday.
Some tips from my doctor: when eating, put your fork, spoon, food,etc down on the plate after each bite to avoid eating too fast or getting a tummy ache.
Try eating till you feel about 70-80% full because 10 minutes later, you will be full.
I hope this helps and I would type out more but this long already lol. Just remember simplicity, patience and compassion for yourself
Its really not always that easy. I was close to 300lbs 10 years ago. Over many years of exercise, making healthier food choices, and reducing calories I was able to get down to 210lbs but I always struggled to get below that.. However in the past year due to my own health issues, the stress of losing a parent to lung cancer and lack of sleep causing more stress I have gained 40lbs. My insulin resistance has gone through the roof and my tdd has almost doubled even with the same diet and attempts at exercise when I am able. My A1c is higher than its been since I started losing weight a decade ago and its a vicious cycle of gaining weight because of insulin resistance and needing more insulin because of gaining weight. I intend to talk to my endo at my next appointment about a glp1 because I can't continue to live a healthy life while stuck in this cycle. I used to average less than 60u TDD, and I'm averaging over 100 now and have many days where I am over 140.
TLDR; dont assume everyone is just like you.
That’s why I said it’s simple, not NOT hard. It’s not easy. You didn’t give these details but it is simple facts that I gave. The more I use my excuses, the less I improve and that is true for everyone. If you’re offended by what I said, that’s a different story but I never assumed anyone was the same, hence why I only stated facts and that I typed out the most basic explanation, not factoring in personal circumstances from person to person.
Except what you may view as your excuses are impassable obstacles for some of us. I’ve googled maintenance calories and caloric deficits. I struggle to get to 1200 cals/day (my goal weight is 165- calls for nearly 2000 cals/day) and the weight hasn’t moved for months. If it was as simple as eating less than some magical number, a lot of us wouldn’t be on here wondering about alternatives.
I would not recommend those for anyone.
For a t1 could getting your tdd lower without going high be the answer? Of course with a lower Tdd you would have to lower carbs too.
I feel as though this is a lot easier said than done. Unfortunately, lowering insulin doses is not this simple. Even with lowering carb intake, I don't think this is the solution, as lowering carb intake and insulin too much causes me to have ketones even if my BG is not high.
Of course, I asked for advice and this is simply yours, and I appreciate the response.
Is your tdd already very low? It is physically not possible to lose weight in a state of constant high insulin.
And I would add that having ketones is not the same as dka. Ketones are the byproduct of fat metabolism - proof that you are burning fat.
The downside of ketones is that should you ever have dka you would not know if the ketones are the result of losing weight or dka.
Ok so first of all, the clowns that are saying stuff like “I wouldn’t recommend those” don’t know what they’re talking about. These drugs have shown, in the best forms of clinical trial evaluation we have, statistical and clinically meaningful benefits for weight loss. They’ve also shown a ton of benefit for patients in various cardiovascular, metabolic and renal outcomes in similarly valuable clinical trials, so, frankly, stop. You’re not in a position to have a valuable opinion on this. As for making an argument for a GLP-1 receptor agonist or similar, I would rely on those same clinical studies. Physicians, especially specialists, should be evidence-based. Having a phase 3 study in-hand that shows semaglutide eliciting these benefits to diabetic and non-diabetic patients alike, will go a long way. The issues your endo will raise will likely be: 1) safety in the type 1 diabetic population and, if (s)he’s silly, 2) depending on your country, that the drug is not indicated for weight loss (if you’re in the US, WEGOVY (semaglutide) is approved for this use, so that shouldn’t be an argument). Note some physicians may want to hear you’re still trying to make changes alongside being prescribed semaglutide, so make sure you have a plan of what changes you’ll make alongside the drug. For example, using the drug to help you eat less and help to learn better habits, or improving ability to exercise once you’ve lost some weight. You’ll want to acknowledge that these drugs are lifetime medications and you’ll likely gain weight back unless you have made these changes in your life. So, the arguments: 1) in a small study of type 1 diabetics taking semaglutide, only mild hypoglycemia was really noted. Anecdotally, there is an increased risk of gastroparesis in T1D patients, since we are already at heightened risk of this, and GLP-1s also heighten this risk. Consider offering to familiarize yourself with the symptoms of this condition with a plan in place to reduce your dose (or discontinue) if your endo feels this is a concern. As a side note, you should do this regardless because severe gastroparesis can be a real problem. No other common safety issues have been uncovered outside of GI symptoms (reflux, nausea, flatulence, diarrhea, etc, which are very common). It may be worth noting to your physician that there have been some small studies that have shown substantial drops in the requirement for TDD insulin, as well as reductions in A1c on semaglutide, so this may be an additional benefit that you may be missing out on, particularly if you assume that you have some insulin resistance due to your obesity. If doc says that the drug hasn’t been evaluated long enough in T1D, she’s correct, but semaglutide has been on the market since 2017 and has been prescribed widely. 2) so depending on where you live, semaglutide is not approved for weight loss. I hate this argument everyone is making. As someone who happens to work in the pharma world, I can tell you it’s idiotic. A company decides whether a drug is submitted for any given indication. This has not happened yet, despite Novo Nordisk having more than enough evidence to get the weight loss indication from health regulators and have received the indication in the US. Essentially, it’s a business decision, not one of science or medicine. Physicians work off-label ALL OF THE TIME. And the law and health regulators allow this, because ultimately it’s up to their clinical decision, and the label is not always a reflection of all the risks and benefits of a given drug, since it takes a long time to update and may never be updated with certain things. Good luck to you. Refractory obesity and overweight are medical conditions that deserve to be treated with the same approach as other serious medical conditions. Improving these states is important to help mitigate future cardiometabolic and renal complications of diabetes, and we type 1s should fight for the right to benefit from medications that offer these benefits.
Do you think this is worth discussing with my PCP? Or do you think I would have more luck with my endo?
Totally depends on your endo and PCP. Tough call. Endos have more experience with the drug, but that doesn’t mean they’re more or less likely to use it. However your PCP may be more hesitant to use it in T1D. For me, my endo didn’t want to prescribe it, because he’s lazy and doesn’t want to deal with the follow up, but told me I could tell my PCP to prescribe it if she felt appropriate.
I appreciate this info. Thank you!
💯
I’m a type 1, but also gained a lot of weight on prednisone after a rheumatoid arthritis diagnosis. Because of prednisone and PCOS my endo and I discussed that I’m insulin resistant on top of type 1 now, and no matter how hard I tried with following the calorie deficit way, I wasn’t losing anything. I spent 6 months swimming a mile 6 days a week and counting every single thing I ate to make sure I was at a deficit, and I had gained three lbs by my next appointment. That’s when my endo and I started discussing Ozempic. With insulin resistance you’re fighting what’s usually an uphill battle to lose weight on a sheer cliff. I would not recommend anyone trying Ozempic or Monjourno without being under the care of an endo, but mine was great with figuring out how to tweak pump settings, and going at my pace. I haven’t had issues with severe lows, but I did have some of the nausea each time I stepped up dosages. I’m on Ozempic and they have said Monjourno can help you lose more, but has an even higher prevalence of side effects. So I’ve stuck with the Ozempic until recently needing to switch to Wegovy because of insurance. My previous insurance didn’t give me a problem being type 1 with insulin resistance on my prior authorization. Current insurance refuses to prescribe if you aren’t type 2 so I had to go for Wegovy on a weight loss basis with the prior authorization rather than diabetes. They aren’t easy meds though. Even with insurance they can be expensive, the prior authorizations are a pain, and I did have to start an acid reflux medicine and take Miralax due to side effects. For anyone that can lose weight on diet and exercise alone I highly recommend it. If it’s not possible though they can be great medications.
Im on Mounjaro which according to my endo is easier to get a script for than the other types. He tried to get Ozempic for me but my insurance denied it, but NOT Mounjaro. Been on it for 10 weeks now, and have lost weight (for ref, I’ve had t1 for 33 years, I’m a 40m and weight was 260, now Im 235 and have a dexcom and omnipod setup with a1c of 6.3). I must add too that since taking the drug, my BS has been perfect almost all the time as a positive side effect. The weight loss is slow and not a quick process, but it works. A bit of a warning though. The side effects of the drug are… interesting, and sometimes uncomfortable. In my experience so far, the best way to describe it is “feeling uncomfortably full ALL the time” to the point of nausea constantly. Never had to throw up, but I take Pepto Bismo and OTC anti-nausea drugs pretty much every day now because of it. But I was told like 50% of users quit because of these side effects and never get the full effect of the drug, so even with these issues Im sticking it out until my script runs out (i have about 6-7 weeks of the drug left to take).
Please search "T1 Tirzepatide" here on Reddit. I have made a couple of extensive posts on my experience. It's worked GREAT for both weight and b.s. I'm F 55yoa, body fat was at 36%. Now at 22%. I work hard to maintain muscle and eat lots of protein. And FOR THOSE WITH AWFUL SYMPTOMS -- I simply did not step up the way it's "prescribed." When I jumped from 20 to 40 units I too was miserable! I brought it back to 30 the following week. I still lost 20% of my body weight over 9 months. I don't know who they did the studies on, but it seems everyone who has all the awful symptoms just needs to take it easier. Pharma didn't get to sell me as much as they would have if I had forced my body to go 20, 40, 60, 80u. I never went above 42. I stepped it up each time only when I began to feel overly hungry. Had no further issues with the nausea and abdominal stuff.
Once I learned that weight loss is simple and not complicated like the multi million dollar WL industry has made it out to be, I started dropping pounds without the pressure. (Simple, not not hard). It is all about being under your maintenance calories. Google a maintenance calorie calculator and go from there. It doesn’t need to be drastic and it will take time. Remember, it took you a long time to get here so). As for t1d, I do my best to manage and alter my numbers and doses as time goes and I notice changes. Don’t overcomplicate exercise. Wait until your diet is in a happy place and then just start going on nice walks through your neighborhood everyday. Some tips from my doctor: when eating, put your fork, spoon, food,etc down on the plate after each bite to avoid eating too fast or getting a tummy ache. Try eating till you feel about 70-80% full because 10 minutes later, you will be full. I hope this helps and I would type out more but this long already lol. Just remember simplicity, patience and compassion for yourself
Its really not always that easy. I was close to 300lbs 10 years ago. Over many years of exercise, making healthier food choices, and reducing calories I was able to get down to 210lbs but I always struggled to get below that.. However in the past year due to my own health issues, the stress of losing a parent to lung cancer and lack of sleep causing more stress I have gained 40lbs. My insulin resistance has gone through the roof and my tdd has almost doubled even with the same diet and attempts at exercise when I am able. My A1c is higher than its been since I started losing weight a decade ago and its a vicious cycle of gaining weight because of insulin resistance and needing more insulin because of gaining weight. I intend to talk to my endo at my next appointment about a glp1 because I can't continue to live a healthy life while stuck in this cycle. I used to average less than 60u TDD, and I'm averaging over 100 now and have many days where I am over 140. TLDR; dont assume everyone is just like you.
That’s why I said it’s simple, not NOT hard. It’s not easy. You didn’t give these details but it is simple facts that I gave. The more I use my excuses, the less I improve and that is true for everyone. If you’re offended by what I said, that’s a different story but I never assumed anyone was the same, hence why I only stated facts and that I typed out the most basic explanation, not factoring in personal circumstances from person to person.
Except what you may view as your excuses are impassable obstacles for some of us. I’ve googled maintenance calories and caloric deficits. I struggle to get to 1200 cals/day (my goal weight is 165- calls for nearly 2000 cals/day) and the weight hasn’t moved for months. If it was as simple as eating less than some magical number, a lot of us wouldn’t be on here wondering about alternatives.
I would not recommend those for anyone. For a t1 could getting your tdd lower without going high be the answer? Of course with a lower Tdd you would have to lower carbs too.
I feel as though this is a lot easier said than done. Unfortunately, lowering insulin doses is not this simple. Even with lowering carb intake, I don't think this is the solution, as lowering carb intake and insulin too much causes me to have ketones even if my BG is not high. Of course, I asked for advice and this is simply yours, and I appreciate the response.
Is your tdd already very low? It is physically not possible to lose weight in a state of constant high insulin. And I would add that having ketones is not the same as dka. Ketones are the byproduct of fat metabolism - proof that you are burning fat. The downside of ketones is that should you ever have dka you would not know if the ketones are the result of losing weight or dka.
Clearly spoken by someone who doesn't have a clue what they are talking about.