GLP-1 medicines are FDA-approved for both weight loss and management of Type 2 diabetes. They are some of the best tools we have to help control blood sugar. But when you take a GLP-1 medicine with other diabetes medicines, the two need to work safely together. Here is what you need to know.
How GLP-1 Medications Help with Type 2 Diabetes
Makes insulin at the right time
These medicines tell your body to make insulin, but mostly when your blood sugar is high. This lowers the chance of your blood sugar dropping too low.
Lowers a hormone that raises blood sugar
They lower a hormone called glucagon. This stops your liver from putting extra sugar in your blood between meals.
Slows digestion
They slow down how fast food leaves your stomach. This keeps your blood sugar from spiking after meals.
Helps with weight
They reduce your appetite, so you may eat less and lose weight. Losing weight helps your body use insulin better too, which can reduce future risk for diabetes.
Medications That Require Close Monitoring
Insulin — Most Important
| Medication |
Interaction |
What to Do |
|
Insulin (all types)
|
Adding a GLP-1 medicine increases your risk of low blood sugar when taken with insulin. These two medicines are lowering your blood sugar at the same time.
|
Discontinue the GLP-1 medicine and notify your Onsera clinician immediately. Do not adjust insulin on your own. Monitor blood sugar closely.
|
|
Sulfonylureas
(glipizide, glyburide, glimepiride)
|
These medicines make your body release insulin no matter what your blood sugar is. With a GLP-1 medicine, this raises the risk of low blood sugar.
|
Discontinue the GLP-1 medicine and notify your Onsera provider. Monitor your blood sugar closely.
|
Generally Safe Combinations
| Medication |
Notes |
| Metformin |
Often taken with GLP-1 medications. In the first few weeks, you may have more stomach upset, like nausea or loose stools. Many patients are able to come off of Metformin as they lose weight with a GLP, but this should be done at the direction of a clinician. Please do not stop medication without talking to your clinician first. |
| SGLT-2 inhibitors (empagliflozin/Jardiance or dapagliflozin/Farxiga) |
Usually safe to take together. They may work together to decrease blood sugar and weight. Make sure you drink enough water. Both kinds of medicine can make you lose fluid. |
Recognizing and Responding to Low Blood Sugar (Hypoglycemia)
| Mild to Moderate Symptoms |
Severe Symptoms — Call 911 |
- Shaking or trembling
- Sweating or chills
- Fast heartbeat
- Feeling dizzy or lightheaded
- Feeling very hungry, worried, or grumpy
- Blurry vision
|
- Feeling confused or unable to think clearly
- Seizure
- Passing out
- Not being able to swallow safely
|
The 15-15 Rule for Low Blood Sugar
- Eat 15 grams of fast-acting sugar — 4 glucose tablets, 4 oz (half a cup) juice, or 4 oz regular (not diet) soda.
- Wait 15 minutes then check your blood sugar again.
- If it is still under 70 mg/dL, follow steps 1 through 3 again.
- Once your blood sugar is above 70 mg/dL, eat a small snack if your next meal is more than an hour away.
- Tell your care team about it. Ask if your medicine doses need to change.
Blood Sugar Monitoring
First 4–6 weeks
- Check blood sugar more frequently when you start or change your dose.
Know your range
- Watch for both high readings (common before the medicine takes full effect) and low readings.
Keep checking
- GLP-1 medications are not a substitute for monitoring — they reduce blood sugar but do not eliminate the need to check.
Write it down
- Keep a log of your numbers to share with your care team at each visit.
⚠️ Contact Your Care Team Promptly if:
You have signs of low blood sugar, like shaking, nausea or sweating. If you feel confused, light-headed or generally unwell, call 911.
Your blood sugar is often under 70 mg/dL or above your goal.
A new provider prescribes you a diabetes medicine and does not know you are on a GLP-1 medicine.
This handout is for educational purposes only and does not replace personalized medical advice from your healthcare provider. Always consult your Onsera care team before making changes to your medications or treatment plan.
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