GLP-1s Started as a Diabetes Medication. Here’s What That Means for Your Plate.
Unless you have been living under a rock, you will have seen all of the press on GLP-1s. They are in the news, all over social media and coming up in conversation with friends and acquaintances (I have lost count of how many people have asked me what I think about them). What you might also have heard is that they didn’t start life as a weight loss drug at all and that they were first developed to treat type 2 diabetes and it was only later that they were adopted for weight loss.
Now, this post isn’t going to get into the weight loss side of things (that is a whole other post and I am definitely going to be writing it). What I want to do in this post is take a step back and give you some background on what diabetes actually is, where a GLP-1 fits into it and, most importantly, what you can do to manage it. Because there is SO much more to managing diabetes than a weekly injection, and nutrition sits right at the very centre of it.
Fair warning, I know that topics like this can be long winded and technical so I have tried to simplify things and not make it too dense.
First, what actually is diabetes?
Roughly 40 million people in the US have diabetes and more than a quarter of them don’t even realize it. In the UK, 4.6 million people now have a diabetes diagnosis and Diabetes UK estimates a further 1.3 million have undiagnosed type 2 diabetes, with about 6.3 million living with pre-diabetes (this is when your blood sugar is higher than it should be, but not yet high enough to be classed as diabetes). Put together, that is more than 12 million people, or one in five adults, either living with diabetes or pre-diabetes.
In both countries, type 2 makes up around 90% of cases, and while it used to be thought of as something that happened later in life, it is now being diagnosed in younger people more and more (in the UK, the number of people diagnosed with type 2 under the age of 40 has risen by 40%).
Ok, that is the numbers done.
A bit about insulin
To understand diabetes, you first need to understand insulin. When you eat, the sugar (glucose) from your food makes its way into your bloodstream (and when I say sugar I don’t just mean the obvious sweet stuff like cake and biscuits, I mean all carbohydrates, because your body breaks things like potatoes, bread, rice, pasta and fruit down into glucose too). Insulin is a hormone made by your pancreas that works like a key that unlocks your muscle, liver and fat cells so that sugar can move out of your bloodstream and be used for energy immediately or stored for later.
When you have type 2 diabetes, one of two things goes wrong (and a lot of the time both do). Either your pancreas isn’t making enough insulin to handle all of the sugar (glucose) in your bloodstream or your cells stop responding to it the way they should, which is called insulin resistance. To keep to the key analogy, the key is still there, it just doesn’t turn as easily anymore. Either way, the sugar stays in your blood, and over time that high blood sugar can damage your blood vessels, nerves, eyes, kidneys and heart.
Although they aren’t the focus of this blog post, there are a few other types of diabetes worth knowing about as I am sure you may have come across them. Type 1 diabetes is an autoimmune condition where the body actually attacks the cells that make insulin and as a result you need insulin treatment for life and this type of diabetes can’t be managed with lifestyle changes alone. Gestational diabetes develops during pregnancy and usually goes once the baby arrives, but it does raise the risk of type 2 later on for both mum and baby. Lastly, there is pre-diabetes. As mentioned above, this is where your blood sugar is higher than it should be but not yet in the diabetes range.
How do I know if I have type 2 diabetes?
Both pre-diabetes and type 2 diabetes rarely come with any obvious symptoms in the early stages which is why a lot of people have no idea they have them and many people live with type 2 for years before it is picked up. Unfortunately by this stage the high blood sugar may already have caused some damage which is why I am a huge advocate for annual blood tests even if you feel fine (not only for diabetes, they can pick up all sorts of things, again, this probably warrants another post entirely).
Some people do notice symptoms though, and they tend to creep up so gradually that it is easy to put them down to getting older or being busy. Some of the more common symptoms include feeling thirsty all the time and needing the loo more often (especially at night), feeling unusually tired, blurred vision, cuts and sores that take a long time to heal, feeling hungry even after you have eaten, recurring thrush or itching, losing weight without trying, and tingling or numbness in your hands or feet. If any of those sound familiar, book an appointment with your doctor rather than waiting to see if they go away.
The good news is, if you do find out you have pre-diabetes, or even type 2 diabetes, it can very often be turned around or improved with changes to how you eat and move (I will cover this later on).
So where does a GLP-1 come in?
This is the part most of the headlines tend to ignore. GLP-1 is actually a hormone your gut ALREADY makes when you eat (yes, you read that correctly, you already have it). Within minutes of you starting a meal, cells in your small intestine release GLP-1, which tells your pancreas to release insulin as your blood sugar rises, slows down how quickly food leaves your stomach and tells your brain that you are full.
The natural GLP-1 your body makes only lasts a few minutes before it is broken down, however GLP-1 medications copy what that hormone does but stay in your body for much longer and have a much stronger effect. That extra help means your body can bring your blood sugar back down after you eat, which is exactly what someone with type 2 diabetes struggles to do on their own. GLP-1 also keeps you feeling fuller for longer, so people on them start losing weight, and that is the part you probably know very well.
There are other medications available that help people with type 2 diabetes, however those aren’t the topic of this post.
But, and it is a big but, medication is only ONE tool. The research is very clear that the foundation of managing type 2 diabetes is lifestyle, and nutrition in particular is described as a fundamental part of diabetes care, whether you are trying to prevent it, manage it or treat it.
You don’t need to cut out carbs (or sugar)
If you have read my story, you will know I have tried every diet going, and if I had been told I was pre-diabetic back then, I would have gone straight to cutting out every carb in the house. That is the diet culture answer, and we all know where that ends up (usually back at square one by Monday). You do NOT need to go zero carb to manage your blood sugar, and you don’t need to give up every food you enjoy either, yes you are going to have to make sacrifices and lifestyle changes, but you don’t have to be miserable.
I also want to clear up the sugar myth while I have you here. Eating sugar doesn’t directly cause type 2 diabetes. Too many surplus calories, whether they come from sugar or anything else, lead to weight gain, and carrying excess weight is the biggest risk factor for diabetes. This is good news, because it means there is a lot you can do about it, and sweets and carbs can still have a place in a balanced way of eating (I’ve written more about why no food is “good” or “bad” in I Used to Live by Food Rules).
Protein and fibre need to do the heavy lifting
If you have been following me for a while, you will know I bang on about protein and fibre all the time, and this is exactly why. Protein keeps you full and helps you build and hold on to muscle while fibre slows down how quickly sugar hits your bloodstream, so instead of a big spike followed by a crash, you get a much steadier rise. Add these two together at every meal and you are doing a lot of the work for your blood sugar before you have even thought about anything else.
In practice, this would look something like swapping refined carbs for whole grains like brown rice, oats, quinoa and wholewheat pasta, adding beans and lentils wherever you can (they are cheap, filling and give you protein AND fibre), filling half your plate with vegetables like leafy greens, broccoli and peppers, choosing lean proteins like chicken, turkey, fish, lean beef, venison and tofu, and including healthy fats from nuts, seeds, avocado and olive oil. For a lot of people, the biggest single change is cutting back on sugary drinks and alcohol, because many of them deliver a huge hit of sugar (and empty calories) with nothing to slow it down.
If you are reading this and you are already on a GLP-1, nutrition matters even MORE, not less. When your appetite drops right down, every meal has to work harder for you delivering your body what it needs, and if you aren’t getting enough protein you risk losing muscle along with the fat. Muscle loss is, quite literally, the last thing you want, because (and this brings me nicely on to my favorite subject) muscle is one of your biggest allies when it comes to diabetes.
Why I will always tell you to lift
Your muscles are one of the main places your body stores sugar for energy. The more muscle you have, the more storage space there is, and the less sugar is left hanging around in your blood. So yes, I am going to tell you to lift weights (you knew that was coming).
The guidelines suggest strength training at least twice a week on non consecutive days, building up to three, and working all of the major muscle groups. If you are just starting out, start lighter and gradually increase the weight as you get stronger (this is known as progressive overload). Alongside that, you would ideally aim for 150 to 300 minutes of moderate activity a week (the NHS and the US guidelines both set 150 minutes as the minimum) and try not to go more than two days in a row without moving. Those numbers sound like a lot however a daily walk after dinner is one of the simplest things you can do, because moving after a meal helps bring your blood sugar down, whatever the activity.
The payoff for your efforts can be huge and losing around 10 to 15% of your body weight can put type 2 diabetes into remission. Unfortunately it isn’t a cure, because the underlying tendency stays with you and old habits can bring it back, but it shows just how much power food and movement alone can have.
You don’t have to figure this out on your own
The research is very clear that someone supporting your nutrition should be a key part of your care team. Unfortunately in both the US and the UK, this support can be hard to come by, with long waiting lists in the UK and limited insurance coverage in the US, so if you have been told you are pre-diabetic, you have type 2 diabetes, or you had gestational diabetes in a past pregnancy, I would really encourage you to get support from a nutrition coach, nutritionist or dietitian alongside your doctor if you can.
None of this is about being perfect and it is going to take both time and effort but if you work at it you will build habits you can stick with for years, not weeks.
If you are worried about diabetes and would like someone to take a good look at your diet, click here to join the waitlist for 1:1 coaching and if you have any questions, come and find me on Instagram and send me a DM, I would love to hear from you.
