What is a GLP-1?

GLP-1 analogues like Ozempic and Mounjaro have received a lot of attention because of recent data that shows they are able to  help both diabetics and non-diabetics lose weight.  But what is a GLP?

GLP stands for glucagon like peptide. A peptide is a small chain or amino acids that our body naturally makes.  Glucagon is a hormone that your pancreas makes to help regulate your blood glucose (sugar) levels in your body.  While GLP has nothing to do with glucagon, the molecular structure is similar. GLP-1 is a peptide hormone made in your gut that tells the pancreas to release insulin in response to glucose levels which is released by the gut when you eat. 

GLP-1 is made naturally and quickly broken down by the DPP4 enzyme in the body. Giving GLP-1 directly to patients would be a challenge in affecting weight and diabetes because it would  be quickly broken down by DPP4.  However, drug companies have made molecules that are similar to GLP-1 called analogues, that work the same way, but last much longer. Ozempic and Wegovy are semaglutide which is one of the GLP-1 analogues. Mounjaro is the newst GLP-1 analogue, and is a bit different because it actually has two peptides in the same molecule- GLP-1 and GIP. 

In addition to telling the pancreas to secret insulin in response to food (which is how it helps control sugar in diabetics), GLP-1 does a few other things.  First, it reduces gastric emptying, which means food stays in the stomach longer.  This makes you feel full.  It also tell the brain that it is full.  These effects on both the stomach and the brain are why GLP-1 analogues like Ozempic and Mounjaro have been so effective in helping patients lose weight. 

However, delaying gastric emptying and signals to the brain also cause side effects, primarily nausea.  This is why when starting a GLP-1 analogue, it is advised to start at a very low dose and slowly increase it.  This allows the body to get used to the side effects.  In most cases, side effects are minimal and go away over time. 

Matthew L. Mintz, MD, FACP

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