Gastric delay in GLP1: how much slowing do we see?
by IDS Director of Patient Care and Education, Alicia Downs
In a new study released by Harvard Medical School Boston published in the American Journal of Gastroenterology a meta-analysis of patients with either diabetes or obesity demonstrated an average 30-minute delay to the time of 50% emptying of solids from the stomach compared to placebo.
More interesting may be that over a 3-4 hour period, there was no appreciable difference in gastric emptying between GLP1 users and placebo. This leads one to question the cause of longer delays in blood sugar rise that we see with Glp1 insulin users.
There was no difference in this timing with regard to what GLP1 medication was used. There was no change in the 50% emptying time for liquids.
What could the takeaways from this study be for people on insulin using Glp1 medications?
The first would likely be that we should stick with liquid options when treating hypoglycemia and taking Glp1 medications. We often hear anecdotal evidence of patients having problems treating hypoglycemia when on Glp1 medications because digestion is delayed and the glucose is not raising blood sugar as fast as their insulin or activity is dropping it. Using a liquid option like cola, honey, sugar water, sports drinks, or even glucose powder mixed with warm water will speed digestion and absorption time.
We can also question additional mechanisms beyond simple gastric emptying in the role of blood sugar rise and GLP1 action. For example upper GI motility changes or enzyme actions. Study limitations may also play a significant role here. What the studies used as “solid foods” A typical “solid food” used in a gastric emptying study would be scrambled eggs and white flour toast. As a person with diabetes, I know that this is a meal that I would anticipate to be moderate to moderate high in glycemic index, and therefore to not have a significant slowing of gastric emptying to begin with, so seeing a GLP1 slow it by only 30 minutes with no differential at 3-4 hours is not surprising. However, if this study were done with 1 cup of lentils the differentials may have been drastically different between the GLP1 and placebo groups as anecdotal evidence often shows that slowing of higher GI foods tends to be less marked than that of lower GI foods in GLP1 users.
Finally seeing a study done with a mixed population of people with diabetes, where studies have shown are more prone to amylin and exocrine insufficiencies that cause underlying gastric slowing, AND people with obesity shown to have significantly lower rates of these insufficiencies is a muddy sample group at best.
Hopefully, the widespread use of these medications will not lead to further mixed population data, but the ongoing push for a type 1 indication will lead to more specified population-based research.
If you would like assistance with your diabetes, give our office a call to schedule an appointment.
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