Thanks, Felix, for sharing your experience with GLP-1 RAs. Obviously you've been experimenting a lot to figure out what's working best for you. Your observations about the differences between various GLP-1 RAs are very valuable. They also highlight how interindividually different the resposnes to thsi class of drugs can be.
You raise an interesting point about gastroparesis and glucose control. It's true that GLP-1 RAs do slow gastric emptying (which is not the definition of gastroparesis, btw), and this contributes to both weight loss (by increasing feelings of fullness) and improved blood sugar control (by preventing rapid spikes after meals). However, this is not the main or only mechanism for glucose control. GLP-1 RAs work in several ways in addition to slowing down gastric emptying:
• Stimulating Insulin Release: GLP-1 RAs directly stimulate the pancreas to release insulin. Most ingeniously, they do this in a glucose-dependent way. This means they only boost insulin when blood sugar is high. That's why hypoglycemia is not so much of an issue with this class of drugs.
• Suppressing Glucagon Secretion: GLP-1 RAs also suppress the release of glucagon, a hormone that raises blood sugar. This is another crucial part of their blood sugar-lowering effect.
• Slowing Gastric Emptying: As you noted, this is a factor, but it's one piece of a larger puzzle.
• Direct effects in peripheral tissues, such as muscles.
So, while the slowed gastric emptying definitely plays a role, it's an oversimplification to attribute all the glucose-lowering effects to this. The effects on insulin and glucagon that I mentioned are essential.
Your concerns about strength loss are very valid and reflect what I discussed in the post. GLP-1 RAs can contribute to muscle mass loss, especially when combined with reduced protein/calorie intake. This is a particular concern for guya aged 60+ as we los muscle mass more rapidly at that older age. So it's crucial to prioritize resistance training and adequate protein intake not only while you are on these meds, but in general.
Your observation of elevated lipase and amylase levels sound like a red flag to me which you should take seriously. These are markers of pancreatic inflammation (pancreatitis), and while rare, pancreatitis is an acknowledged potential side effect of GLP-1 RAs. I hope you have discussed this with your doctor, and you should continue to monitor your lipase and amylase levels regularly. I wouldn't ignore this because pancreatitis can be a nasty condition.
Given your history of elevated pancreatic enzymes, I also wouldn't do a gung-ho switching between different GLP-1 RAs without close medical supervision.
Since you previously managed your diabetes well with an HbA1c below 7, and given the side effects you're experiencing, a GLP-1 RA may not be the best option for you. But you'll discuss those other options with your doctor, I guess. One of those options is appropriate lifestyle change.
