"Dear Doctor: Should I take weight loss drug with Type 1 diabetes and retinopathy?"

From oregonlive.com

Dear Dr. Roach: I’m a 73-year-old female who has Type 1 diabetes that began as Type 2 diabetes more than 30 years ago. I have a very strong family history of coronary artery disease, and I personally have a cardiac stent. I use an insulin pump and have good control with carb counting. I struggle with my weight (160 pounds at 5 feet, 2 inches tall) and with controlling my insulin dose. My A1C is 5.8%. I have ocular hypertension and some diabetic retinopathy. I receive Avastin injections in my eye approximately every two years.

My physician has ordered Mounjaro for weight loss. My concerns are my diabetic retinopathy and the diagnosis of Type 1 versus Type 2 diabetes. What are your thoughts on the safety of starting Mounjaro? -- C.D.C.

Answer: Type 1 diabetes is very different from Type 2. Type 1 diabetes is often diagnosed in childhood or adolescence and is an autoimmune disease that attacks the cells in the pancreas (islet cells), which make insulin. People with Type 1 diabetes have very little to no insulin.

People with Type 2 diabetes make normal or even high amounts of insulin. With Type 2 diabetes, the primary problem is resistance to insulin. Insulin can be used, but newer therapies are designed to reduce insulin needs.

Many people with latent autoimmune diabetes in adults (LADA) are initially misdiagnosed with Type 2 diabetes, and I suspect that this is your actual diagnosis. A diagnosis of LADA is typically made after age 30. (It sounds like you had problems beginning around age 40.) There’s no insulin requirement for at least six months, and blood tests confirm the presence of islet-cell antibodies. People with LADA usually have Type 1 diabetes.

You have disease in both the small blood vessels (Avastin is used for diabetic retinopathy, a small vessel disease) and large vessels (the stent in your coronary artery), which can happen with either type of diabetes but is consistent with Type 1. There’s strong evidence that GLP-1 drugs are helpful in preventing heart attacks in people with Type 2 diabetes but not for those with Type 1 (although they still may be helpful).

Your question is about the use of tirzepatide (Mounjaro when used for diabetes) for Type 1 diabetes. Your A1C is in the nondiabetic range; I don’t recommend new medication to lower your A1C further, so it seems like you’d be using it for weight. The expert opinion does recommend medicines like tirzepatide for weight loss in people with Type 1 diabetes who are obese, but your BMI of 29.3 doesn’t meet the definition of obese.

So, there is a safety issue in that even modest doses of Mounjaro could cause a drop in your blood sugar. Having an insulin pump (especially when combined with a continuous glucose monitor) can reduce this risk. But if you do go on Mounjaro, you should pay careful attention and regulate your carbohydrate intake to avoid ketosis (ketones in the urine, which show inadequate cellular nutrition and put you at risk for diabetic ketoacidosis). The normal dose escalations used for obesity or for Type 2 diabetes may be too aggressive, so your doctor should increase the dose very slowly.

You may also be at a higher risk for the nausea and vomiting that is common among people taking GLP-1 agents, although most people with Type 1 diabetes did develop a tolerance to the drug. In summary, Mounjaro may be effective at helping you lose weight, although your blood sugar and ketone levels should be monitored by an expert.

https://www.oregonlive.com/advice/2026/07/dear-doctor-should-i-take-weight-loss-drug-with-type-1-diabetes-and-retinopathy.html 

Drug that delays onset of type 1 diabetes approved in England and Wales

From theguardian.com

Availability of teplizumab on the NHS – which postpones early stages of disease for up to three years – described as an ‘incredible moment’

The world’s first drug to delay the onset of type 1 diabetes is to be made available on the NHS in England and Wales, in the biggest breakthrough in tackling the disease for more than a century.

Millions of people have type 1 diabetes worldwide, which typically emerges during childhood or adolescence, and occurs when the pancreas makes little or no insulin. Insulin is a hormone the body uses to allow glucose to enter cells to produce energy.

The immunotherapy, teplizumab, does not cure type 1 diabetes, but postpones its onset for as long as three years, according to the National Institute for Health and Care Excellence (Nice), which gave the drug the green light on Tuesday.

Its arrival marks a huge step forward. The therapy gives those deemed at high risk of symptomatic type 1 (stage 3) diabetes the chance to delay its onset for the first time in the history of the disease.

By delaying the onset, people will benefit from years of extra time before facing the heavy demands of lifelong diabetes management. Children and teenagers in particular will have more time to reach key developmental milestones before that point.

Nice approved the drug for use in adults and children aged eight and above with early, pre-symptomatic type 1 diabetes (stage 2), enabling them to live more normal lives for longer.

The only other treatment for the disease – insulin – was discovered 105 years ago and does not alter the course of the disease. It simply replaces what patients are missing.

“Today’s landmark approval of teplizumab marks the start of a new age of type 1 diabetes treatment,” said Dr Elizabeth Robertson, director of research at the charity Diabetes UK. “For the first time in 100 years, we are moving beyond insulin, with a medicine that targets the root cause of the condition.

“This is an extraordinary moment for celebration in the type 1 diabetes community, and represents a shift towards a future where type 1 diabetes can be prevented altogether.”

"For the first time in 100 years, we are moving beyond insulin," the Diabetes UK charity said. Photograph: Jeff Moore/PA

Teplizumab, also known as tzield and made by Sanofi, will offer those in the early stages of type 1 diabetes years “free from the relentless demands” of managing the condition with insulin, as well as valuable time to prepare, Robertson said.

“Detecting type 1 diabetes early, before symptoms appear, is key to unlocking these benefits and our focus now is ensuring fair and equitable access for everyone who is eligible.”

Teplizumab trains the immune system to stop attacking pancreatic cells. It is given through a drip into a vein once a day – which takes about 30 minutes – for 14 days in a row.

The dose starts low and gradually increases. Once the 14-day course is complete, that is the end of the treatment.

Karen Addington, chief executive of the diabetes charity Breakthrough T1D, said the drug’s approval marked an “incredible moment” for the type 1 community. “For the first time, we have an immunotherapy that can delay the onset of symptomatic type 1 diabetes.

“If it were your child or someone you love, you would want to do everything possible to give them more years without the daily burden of managing this relentless condition. We now have a treatment that can help make that possible.”

Sanofi has agreed a commercial arrangement with NHS England, the Guardian understands, meaning teplizumab will be available to the NHS at a confidential discounted price.

Helen Knight, director of medicines evaluation at Nice, said the decision to approve the drug was rigorous, transparent and based on the best available evidence, striking a balance between clinical benefit and value for taxpayers.

“This is a genuinely exciting recommendation. For the first time, we have a treatment that can give people diagnosed at an early stage of type 1 diabetes precious extra time before they need to manage the full demands of the condition.”

https://www.theguardian.com/society/2026/jun/23/drug-that-delays-onset-of-type-1-diabetes-approved-in-england-and-wales

New Oral Diabetes Drug Lowers Blood Sugar and Helps With Weight Loss

From libyaupdate.com

Washington – Results from an international clinical trial show that a new oral drug for type 2 diabetes effectively lowers blood sugar levels and leads to significant weight loss. The drug could provide patients with an easier alternative to injectable treatments.

Researchers, led by Mass General Brigham in the United States, said the new medication may expand options for people with type 2 diabetes. The study was published in The Lancet.

Type 2 diabetes is one of the most common chronic diseases. It occurs when the body cannot use insulin properly or does not produce enough, leading to high blood sugar and increased risks of complications such as heart, kidney, nerve, and eye problems.

The researchers tested a new drug called licoglifron, an oral medication still in development. It belongs to the class of GLP-1 receptor agonists, which includes several drugs already used to treat diabetes and obesity.

Licoglifron mimics the effect of the natural GLP-1 hormone by stimulating insulin release when blood sugar rises. It also reduces production of glucagon, the hormone that raises blood sugar, slows stomach emptying, and increases feelings of fullness. These effects help control weight and improve blood sugar management.

The trial included 406 people with type 2 diabetes in nine countries. Participants were randomly assigned to receive different doses of the drug or a placebo.

After 26 weeks of treatment, up to 72.3% of those taking the drug lost at least 5% of their body weight, compared to just 20.2% in the placebo group. The drug also improved blood sugar control. Up to 89.6% of those who took licoglifron achieved an HbA1c level below 7%—the recommended target for most diabetes patients—while only 24.9% of the placebo group reached this goal.

Researchers highlighted that the drug is taken as a pill, unlike most GLP-1 therapies that require injections. This could make treatment easier for patients in the future.

https://libyaupdate.com/new-oral-diabetes-drug-lowers-blood-sugar-and-helps-with-weight-loss/ 

New Ozempic Pill Could Revolutionize Type 2 Diabetes Treatment. Here's How (USA)

From healthline.com

• The GLP-1 medication Ozempic is now available in pill form for people with type 2 diabetes.
• The oral tablet is a reformulated version of the current Rybelsus pill but comes in smaller doses.
• Experts say the pill may be a better alternative for people who don’t want to administer weekly injections of Ozempic.

A pill form of the widely prescribed GLP-1 medication Ozempic is now available in the United States.

Officials at Novo Nordisk have announced that an oral tablet version of the GLP-1 drug became available on May 4 for adults diagnosed with type 2 diabetes.

The Ozempic pill is replacing Novo Nordisk’s Rybelsus daily oral medication, which was approved in 2019 for type 2 diabetes by the Food and Drug Administration (FDA) in 3 milligram (mg), 7 mg, and 14 mg doses.

The Ozempic daily pill is a reformulation of Rybelsus and comes in 1.5 mg, 4 mg, and 9 mg doses.

Novo Nordisk officials say the new formulation delivers the same efficacy and safety profile as the originally approved formulation, but at a lower dose.

Ozempic will also remain available as a weekly injection for diabetes treatment. It is also commonly prescribed off-label for weight loss.

This is the third GLP-1 medication to be approved in pill form this year. In January, FDA regulators gave the OK for another Novo Nordisk product, Wegovy, to be sold as an oral tablet. Wegovy is approved for use for weight management.

In April, the FDA also approved the Eli Lilly medication Foundayo in pill form, but the agency ordered the company to study the heart, liver, and other potential risks associated with this new pill. Foundayo has been approved for use in weight management.

Novo Nordisk officials say they expect a decision from federal regulators on a 25-mg Ozempic tablet dose by the end of 2026. They add that the new pill provides more options for patients.

“With an updated formulation and new branding, oral semaglutide, now under the Ozempic name, helps patients and healthcare professionals more easily recognize the available FDA-approved treatment options for type 2 diabetes that contain the semaglutide molecule,” said Michael Radin, MD, the executive medical director for Novo Nordisk.

“By offering Ozempic in both a pill and injection form, patients can work with their healthcare professional to pick the option that best fits their lives and daily routines,” Radin told Healthline.

Pouya Shafipour, MD, a family and obesity medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, said a pill form of Ozempic will likely be more appealing to many people than an injection.

“A lot of people are needle-averse,” Shafipour told Healthine. “Over the long term, a lot of people get tired of poking themselves.”

Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, said the significance of the new Ozempic-branded pill is that it “carries greater name recognition.”

        Ozempic is now available as a reformulated oral tablet for people with type 2 diabetes. Image courtesy of Novo Nordisk

Who’s eligible for the new Ozempic pill?

A diagnosis of type 2 diabetes and a prescription are needed for a person to obtain the new Ozempic pill.

Novo Nordisk officials say the oral tablet will be available in more than 70,000 pharmacies in the United States.

They add that the Ozempic pill will be covered by insurance for most patients with type 2 diabetes, at as little as $25 for a 3-month prescription.

People who don’t want to use insurance can purchase the tablets through the NovoCare Pharmacy or certain telehealth providers for $149 for the starting dose of 1.5 mg, $199 per month for the 4 mg pills, and $299 per month for the 9 mg pills.

Company officials say the Ozempic pill is effective in improving blood sugar levels when taken in conjunction with a healthy diet and daily exercise.

They add that the pill has also proven effective in reducing the risk of major cardiovascular events such as heart attack, stroke, or death in those who are also at high risk for these events.

Radin said it’s important for people to know that the Ozempic pill is not the same as the injection.

“Oral and injectable Ozempic are not interchangeable. Before a patient considers any transition between formulations, they should consult a healthcare professional,” he said.

Ozempic, whether in a pill or an injection, can produce side effects in some people. Some of the common side effects are:

• abdominal pain
• constipation
• diarrhea
• nausea

Shafipour said more GLP-1 medications may be offered in pill form in the near future, as scientists appear to be solving the “absorption issue.”

Shafipour explained that injections go directly into the bloodstream, so they are absorbed quickly by the body. He said that pills take longer to be absorbed, so a higher dose has been necessary to achieve the same effectiveness.

He said higher doses can lead to more side effects and less weight loss success. Having a pill in smaller doses may reduce that likelihood.

Ali said that he expects to see an increase in the use of GLP-1 oral tablets. “Most people are more comfortable with pills than injections, so I believe we will see more oral medications for the treatment of diabetes and obesity in the future,” he told Healthline.

Pros, cons of oral GLP-1 pills

Shafipour said there are several advantages to a pill form of a GLP-1 medication.

He noted that many people are more comfortable with taking a pill than sticking themselves with a needle.

Shafipour added that injections need to be refrigerated, so pills can be more convenient when traveling. Pills are also generally less expensive.

Nonetheless, Shafipour said some people prefer the injection because they only have to administer a treatment once a week.

There’s also the requirement that a GLP-1 oral medication be taken on an empty stomach.

Ali agrees there are pluses and minuses for both forms of GLP-1 drugs.

“The advantages of the pill form include ease of use, transport, and storage as well as lower manufacturing costs,” he said. “The disadvantages are slightly lower efficacy and the requirement for daily use rather than weekly injections.”

What to know about GLP-1 drugs

GLP-1 medications work by suppressing appetite. They do not cause weight loss or improve blood sugar levels on their own.

Experts say it’s important for people taking these drugs to also adopt healthy lifestyle habits.

Shafipour said people should talk with their doctor to develop a plan before starting a medication routine.

“People should realize that these are long-term drugs,” he said.

Shafipour points out that the body can adapt to medications, so the drugs can become less effective over time for weight loss and blood sugar control.

He said that’s why it’s important to eat a healthy, protein-rich diet and to maintain a consistent exercise schedule that includes strength training.

Ali agreed. “These medications work by reducing hunger and slowing gastric emptying so that the patient feels full for longer,” he said.

“Most studies indicate that these medications must be taken long term, as weight is easily regained once treatment stops. It is also important to make significant dietary and lifestyle changes to see optimal results,” he noted.

https://www.healthline.com/health-news/novo-nordisk-ozempic-pill-diabetes-treatment

6 Supplements That Can Interfere with Blood Sugar Medications

From verywellhealth.com

Many people with diabetes or prediabetes try supplements to help control their blood sugar. However, some supplements can change how prescription diabetes drugs work—either by lowering blood sugar too much, or by affecting how much your body absorbs the drug.

                                            Certain supplements can affect how diabetes medications work.    agrobacter / Getty Images

1. Berberine

Berberine can add to metformin’s effects, meaning stronger glucose-lowering and gastrointestinal (GI) effects

Berberine (from plants such as Berberis) has blood sugar (glucose)-lowering effects and is sometimes used as a “natural” alternative to metformin. Studies and reviews have shown similar mechanisms between berberine and metformin. For example, both can help reduce the amount of glucose produced by your liver. This can lead to additive or synergistic effects when taken together, so your blood sugar may drop too low. The similar effects also mean that GI side effects can be worsened.

Talk to your healthcare provider before planning to take berberine. If you are also taking metformin or another glucose-lowering medication, you may need to closely monitor your blood sugar levels and review your dosing with your provider.

2. Cinnamon

Cinnamon can increase the risk of low blood sugar when combined with medications.

Cinnamon and cinnamon extracts have been reported in multiple trials and reviews to modestly lower fasting glucose and haemoglobin A1c (average blood sugar level over two or three months) in some people.

This effect means that cinnamon supplements can enhance the glucose-lowering effect of prescription medications, such as sulfonylureas or insulin, especially when taken in concentrated form rather than as a sprinkle of the spice. 

Clinical evidence is mixed, but caution is warranted. "Natural” doesn’t mean harmless, and you should check your blood glucose more often if you start taking a cinnamon supplement.

3. Ginseng

Unpredictable effects mean ginseng may increase or decrease the effect of prescription diabetes medications.

Different ginseng preparations (e.g., American, Asian) and study designs produce inconsistent results, but studies show that ginseng can affect insulin secretion, glucose uptake, and postprandial (after a meal) glucose.

In individuals already taking oral blood sugar-lowering drugs or insulin, ginseng may have the potential to cause additive glucose-lowering effects, which can lead to hypoglycaemia (too low blood sugar), or alter their responses to these medications.

Commercial ginseng products can vary widely in potency and formulation. Be sure to consult with your healthcare provider before starting this supplement.

4. St. John's Wort

St. John's wort may change drug metabolism, affecting how much of your diabetes medications get absorbed.

St. John’s wort increases the activity of CYP3A4 (a drug-metabolizing enzyme in the body) and certain drug transporters (proteins responsible for drug absorption, distribution, and elimination). As a result, it can reduce the blood levels of medications that share these pathways. For this reason, it is notorious for interacting with many different medications. 

While many diabetes drugs do not get broken down by the CYP3A4 enzyme, St. John’s wort has been shown to alter the way metformin works in your body in at least one trial. It can also interact with many other medications.

Stage TB, Pedersen RS, et al. Intake of St John's wort improves the glucose tolerance in healthy subjects who ingest metformin compared with metformin alone. Br J Clin Pharmacol. 2015;79(2):298-306. doi:10.1111/bcp.12510

Because of its unpredictability with interactions, it's recommended to avoid combining St. John’s wort with complex medication regimens without supervision from your healthcare provider.

5. Aloe Vera

Aloe vera can lower glucose and interact with diabetes medications.

Aloe vera has been studied for its effects on processes that contribute to high blood sugar levels. Studies suggest that it may be beneficial in reducing fasting glucose and haemoglobin A1c levels, particularly in stabilising blood sugar levels after meals.

However, the extent to which aloe vera affects blood sugar levels is unknown. Tell your healthcare provider if you are taking an aloe vera supplement. Keep in mind that aloe vera formulations also vary, and some can cause side effects, such as GI upset.

6. Chromium

Chromium supplementation has shown modest improvements in insulin sensitivity and haemoglobin A1c in some studies. Other studies have shown benefit only in people with poor nutritional status or already low chromium levels. 

Because chromium can enhance insulin action, using it with a prescription blood sugar-lowering drug can raise the risk of hypoglycaemia, especially if the doses are higher than those found in multivitamins.

According to the Food and Drug Administration (FDA) and the Institute of Medicine, it is safe when taken at a dose of 200 micrograms daily for up to six months.

Keep in mind, chromium supplements may also carry side effect risks like GI upset or headaches. Caution should be used if you have kidney or liver issues. Talk to your healthcare provider about whether chromium supplements may be beneficial for you.

Always inform your healthcare provider and/or pharmacist about any supplements and include them on your list of medications—even “natural” ones—so medication dosing and monitoring plans can be adjusted as needed.

https://www.verywellhealth.com/supplements-to-avoid-with-blood-sugar-medication-11864779