How do diabetes drugs work, from insulin to metformin to GLP-1?
One of today's most talked-about drug classes began with a lizard that eats only once or twice a year.
โถ Start the storyDiabetes drugs work by reaching the same target, blood sugar, from different directions. Insulin replaces the hormone itself. Metformin mainly lowers the liver's glucose output and makes tissues more sensitive to insulin. GLP-1 drugs mimic a hormone released in the small intestine that can increase insulin secretion and hold back glucagon. SGLT2 inhibitors make the kidneys lose more glucose in urine.
Replace or reduce
- Insulin: the hormone itself
- Metformin: less glucose made by the liver, more insulin sensitivity
Mimic or spill
- GLP-1 agonists: mimic a gut hormone
- SGLT2 inhibitors: less glucose reabsorbed in the kidney
Insulin is the oldest. In type 1 diabetes endogenous insulin production is extremely low or absent, so the body requires insulin from outside. Since 1982, biosynthetic human insulin has been made by genetic engineering using recombinant DNA technology.
Metformin is described as the main first-line medication for the treatment of type 2 diabetes. It works by decreasing glucose production in the liver, increasing the insulin sensitivity of body tissues, and increasing GDF15 secretion, which reduces appetite and caloric intake. One source adds that its molecular mechanism is not completely understood.
GLP-1 receptor agonists activate the GLP-1 receptor, lowering blood sugar and reducing appetite and energy intake. Their activation slows gastric emptying, inhibits glucagon release and stimulates insulin production. Natural GLP-1 has a half-life of only about two minutes in the body, and a lizard's venom mattered here: in 1992, John Eng isolated a substance, exendin-4, from Gila monster venom that looked like GLP-1 but lasted far longer.
This describes how the drugs work, as the sources report it. Which medicine suits which person is a decision for each person with their clinician.
Quiz me
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Recap
Insulin replaces, metformin quiets the liver, SGLT2 drugs spill sugar through the kidney, GLP-1 drugs imitate a gut hormone.
๐ก A trick to remember it ยท Replace, quiet, spill, imitate: four ways to move one number.
Surprising fact ยท Exendin-4, from Gila monster venom, resembled GLP-1 in lowering blood glucose but lasted much longer.
Connects to
- ๐ How do continuous glucose monitors and "artificial pancreas" systems work?
- ๐ฉธ What are type 1, type 2 and gestational diabetes, and why do they differ?
- ๐ What does insulin actually do in your body?
- ๐ How does a drug find the right cells in a whole body?
- ๐งช Why do nine in ten drugs that reach human trials never get approved?
Sources (5)
No source, no claim. Every fact in this lesson (16 claims) cites at least one of these.