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Trulicity (dulaglutide) is a recently FDA-approved medication for diabetics who have trouble controlling their appetites and losing weight. Taken once a week by injection, this drug can mimic many of the effects of weight loss surgery, without surgery.

Doctors who treat diabetics often become extremely frustrated with their patients' weights. Diabetics themselves find the whole topic even more frustrating.

The dilemma of good blood sugar control is that nearly everything diabetics do other than diet and exercise to keep their blood glucose levels on an even keel tends to add on the pounds. That is because insulin doesn't just help transport sugar into cells from the bloodstream. It also helps fat cells keep fatty acids locked inside.


The Diabetics' Weight-Loss Dilemma

A doctor who treats diabetes but doesn't have diabetes may not have a sympathetic view of what this really implies. Most of the pills released before 2010 and insulin injections do lower blood sugars. The problem is, taking enough of the medication (sometimes) or insulin (more often) to keep blood sugars controlled can make blood sugars run too low. When this happens, appetite increases. A diabetic who can stick to her food plan when her blood sugars are 90 mg/dl (5.5 mmol/L) may want to eat everything in sight when her blood sugars are 45 mg/dl (2.8 mmol/L). 

Overeating to compensate for iatrogenic hypoglycemia leads to blood sugar levels that go from too low to too high, and most of the older approaches to this problem corrected the correction by either a shot of insulin, or a medication that forces the body to produce more insulin.[1]

However, when blood sugar levels are high, fat cells can't respond to a chemical called hormone-sensitive lipase. This compound enables fat cells to liquify the fat they store so it can go into the bloodstream to be burned by the muscles. Diabetics who are on a seesaw of blood sugar up's and down's can burn calories when they exercise, but they have a harder time burning fat.[2]

That doesn't mean that it would be impossible for diabetics to burn off their extra weight. But then there is the problem of crashing blood sugars that start the whole cycle all over again. Most type 2 diabetics get fatter and fatter even though they work harder and harder to control their intake. Most of their doctors aren't sympathetic to their plight.

A Different Approach To Lowering Blood Sugar Levels

About 2007, pharmaceutical companies began to release a series of products that were designed to tackle the problems of diabetic appetite control in a different way. These products are known as incretin mimetics (chemicals that imitate the action of a hormone called incretin) or glucagon-like peptide-1 inhibitors (also known as GLP-1 inhibitors, the acronym pronounced "glip").[3]  

These medications don't increase the production of insulin. They decrease the production of another hormone called glucagon.[4]

Insulin lowers blood sugar levels. Glucagon raises them. When a healthy person eats a carbohydrate food, about as soon as the food is tasted, the pancreas releases insulin to lower blood sugar but also glucagon to raise blood sugar, just in case the food tastes sweet but doesn't digest into sugars. Diabetics lose the ability to release insulin, but they retain the ability to release glucagon. When diabetics use diet foods, their bodies still release glucagon, raising their blood sugar levels. The GLP-1 inhibitors interfere with this process.

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