The Truth About Trulicity, The New Wonder Drug For Diabetic Weight Loss

Doctors who treat people who have diabetes 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 who doesn't have diabetes themselves may not have a sympathetic view of what this condition really implies — how easy it is for someone with diabetes to gain weight, and how hard to lose it, if they are taking the most commonly used medications.

Most of the diabetes pills released before 2010 and insulin injections do lower blood sugar levels. The problem is that taking enough of the medication (sometimes) or insulin (more often) to keep blood sugars under control can make blood sugars run too low. When this happens, a patient's appetite is going to increase, sometimes exponentially. A diabetic patient 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). 

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 ups and downs can burn calories when they exercise, but they have a much 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 caloric intake. Most of their doctors aren't sympathetic to their plight.

A Different Approach To Lowering Blood Sugar Levels

In about the year 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]  

READ Could You Have Type 1 Diabetes And Not Know It?

Insulin lowers blood sugar levels. Glucagon raises them. When a healthy person eats a carbohydrate-rich 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.

What's Different About Trulicity For Diabetes?

This all gets a little technical. It may help to review.

• Diabetics either don't make enough insulin or their bodies don't respond to insulin. Insulin lowers blood sugar levels.
• Diabetics usually retain the ability to make glucagon, a hormone that raises blood sugar levels.
• A healthy pancreas releases both insulin and glucagon when the taste buds sense that the human they are attached to is eating a food rich in carbohydrates. A diabetic pancreas just releases glucagon.

The GLP-1 inhibitors, like Byetta (exenatide) and Victoza (liraglutide) reduce the production of glucagon, and if the diabetic patient has enough functioning insulin-producing beta cells left, restore the ability to release a tiny push of insulin into the bloodstream just as glucose is entering the bloodstream to keep blood sugars under better control. [3]

Not Quite Without Side Effects

Unfortunately, that's not quite all they do. They can also trigger intense diarrhea. In a few instances, often enough that most doctors who prescribe them have run into at least one case, they cause pancreatitis, a potentially fatal disease. These drugs have to be injected every day, because the medication they contain would be broken down in the stomach if it were taken as a pill or capsule.

Still, some diabetics found that taking Byetta or Victoza allowed them to:

• eat about 20 percent less at every meal and feel full and
• manage their blood sugar levels with less oral medication or less insulin. [5]

When a diabetic's body needs less insulin, it can "let go" of fat, and the weight-loss benefits of exercise are a great deal easier to achieve. Many diabetics using these medications lose about a pound a week (2 kilograms a month) without consciously having to restrict their diets. However, the concept of GLP-1 inhibitors needed a little fine-tuning. That's where Trulicity (pronounced Tru-li-si-tee) comes in.

What's Different About Trulicity?

Trulicity, which is made by the Eli Lilly Company, only has to be injected once a week. This medication comes in a pre-filled cartridge. Users just take off the cap, place the cartridge against the skin of the abdomen or upper arm, turn a dial until an arrow matches up with a green line, press a button, and wait until they hear the second of two clicks. Trulicity is a user-friendly medication.

The first dose of Trulicity can cause diarrhea. That's because Trulicity affects the production of GLP-1 in cells throughout the lining of your colon. (You may sense this.) The medication is extremely unlikely to cause pancreatitis. The way to tell the difference is that diarrhea can be uncomfortable in the sense that muscles are tight and ready to "go." Using the toilet relieves the pain. Pancreatitis causes intense abdominal pain, and sensitivity to being touched, that won't go away. However, even minor problems tend to go away after the first few days.

What's A Reasonable Expectation For Trulicity?

Trulicity is one only a few diabetes drugs (such as insulin itself) that do more to lower HbA1C levels than the more commonly used medication for diabetes metformin. It's essentially as safe as metformin. The drops in blood sugar levels aren't dramatic, but they typically run 0.8-1.2 percent in HbA1C. That's equivalent to getting 18 mg/dl (1 mmol/L) drops in your blood sugar readings on a regular basis.

READ New: Once-A-Week Injectable Drug For Diabetes

Commentators who don't have diabetes usually don't realize that insulin for diabetes usually costs $1000 to $2500 a month. In the United States, even if you have health insurance, you are still paying $100 to $300 a month in copays. Trulicity is subsidized by the company so just about anyone can get it for no more than $6 a week. (It costs $500-550 per month without the private subsidy. You may have to register a card given to you by the pharmacy, or from the Trulicity website.) You may save money, if you are on insulin, by taking Trulicity. You may save several thousand dollars per year. Trulicity reduces (it doesn't completely eliminate) a diabetes patient's need for insulin. You have to take your blood sugar levels yourself to know for sure that you don't need as much insulin for glycemic control.

Beyond that, weight gain becomes possible. You still have to do your part by getting some exercise. However, if you do, your body may finally be able to burn the fat that it's kept locked away in storage for years. For most diabetics, that is the result that is truly wonderful, which is why some people are calling Trulicity a wonder drug for diabetic weight loss.