#63 - Are More GLP-1 Medications The Answer for Type 2 Diabetes?

“Start GLP-1 meds earlier” sounds like a clean, modern solution to type 2 diabetes. But what happens when that advice quietly assumes diabetes is “naturally progressive” and that needing more medication over time is simply your fate? 

A loyal listener sent us an article about the benefits of starting a GLP-1 earlier in Type 2 diabetes. In this episode, we give GLP-1 drugs their credit while calling out the “progressive and inevitable” story that can keep people stuck in medication dependence instead of rebuilding muscle, habits, and agency.

We also cover:

 • Why GLP-1 medications are some of the most effective diabetes drugs to date
 • Why metformin stays first line for many people
 • How cost, insurance coverage, and prescribing habits shape “standard of care”
 • What feels wrong about calling type 2 diabetes naturally progressive
 • Using medication as a bridge while building lifestyle skills
 • How sponsorships and incentives can bias health information
 • The question to ask if a medication disappeared tomorrow

Check out the article we reference here: https://tcoyd.org/2026/04/starting-a-glp-1/?utm_id=97757_v0_s00_e227_tv0

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Brian & Cory
    Diabetes Remission Partners

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Transcript

Remission Roadmap And Core Belief

SPEAKER_01 0:02

If you have type 2 diabetes and you're tired of being told it's chronic and something you'll just have to manage forever, if your ail se is controlled but your medication that keeps growing or stays the same, then you know deep down you're capable of more than that. You're in the right place. This is the Diabetes Remission Roadmap Podcast for Brian Bitcher and Corey Jenks, two pharmacists who spent over two decades inside healthcare. And we started this show because we got tired of watching capable people stuck getting managed instead of rebuilt. Here's what most people aren't told. Type 2 diabetes isn't just a blood sugar problem. It's a muscle and energy storage problem. When your body loses strength and metabolic flexibility, blood sugar arises. And you can rebuild that. On this show, we break the script to say more meds are inevitable, you're destined to just manage, remission is impossible, and instead we teach you how to build muscle, eat in a way that keeps you full, and regain control of your health again. No extremes, no shame, just practical strategy to help you move toward remission and lead your health again. Let's get to work.

Live From Florida And Setup

SPEAKER_00 0:59

Welcome back to another edition of the Diabetes Remission to Roadmap podcast. And Brian, we're live in person and we took this one on the road.

SPEAKER_01 1:06

Yeah, we're down in Florida. We're not on a plane, like we talked about that one time, but we are in person.

SPEAKER_00 1:12

Yeah, and on and on a trip, just not actively traveling. So uh we wanted to we wanted to get to you even though we were on vacation because the diabetes does not take a break, and nor do we. No. Um and and I would say diabetes doesn't sleep, and based on the sleep habits of my kids this trip, nor do I.

SPEAKER_01 1:28

So yeah. You were telling me the story about this morning where I said, Hey, I'm glad you slept in.

SPEAKER_00 1:33

Sounds like you got more sleep, and yet the answer, well, there was a big middle part where I did not sleep. So uh we could talk all about our vacation, but that's not what we're here to

Article Claims Start GLP-1 Earlier

SPEAKER_00 1:42

do. We we have a a listener-submitted article that uh a little spicy topic about GLP1 medications. And so the article itself will link to it in the show notes so that you can read it for yourself. But it's called The Benefits of Starting a GLP1 Earlier in Type 2 Diabetes.

SPEAKER_01 1:57

Okay.

SPEAKER_00 1:58

Sounds interesting. It is. Uh, and we are we are the diabetes remission roadmap, so uh we probably have opinions about this. And this particular person, this listener, thanks for sending it to us. And if you see something, remember, send us to us in a DM or an email. But they they're curious about the discussion on whether clinical practice is moving in that direction of starting GLP1s earlier. And they said the arguments in this article make sense, but only if it works as a short-term intervention to stall regression of disease. Uh, also the argument that insurance should make this more affordable. And so the gist of this article is that GLP1 medications, and we're not gonna actually go into the weeds of what GLP1s do, act, how are Ozempic, uh, Manjaro is like a cousin of Ozempic, the Triplicity, Trillicity, those are the names of GLP1s. Uh, and they, let's be honest, Brian, in the world of diabetes medications, they're about the best we've had so far. Yeah. So I agree. When you and I finished pharmacy school, I mean it was metformin, sapanirias, lyclipozide, there were GLP ones out, but they were daily or twice daily, and they weren't as effective. They hadn't been uh refined the way they have by big pharma, they had insulin. Uh, and we have new medications in the repertoire that not only lower sugar but actually improve outcomes. So we have to give the medication its due. We're not gonna be just automatically anti-medication front. Um, if you're struggling with sugars and you've not implemented lifestyle, then yeah, the damage is happening when your sugars are high.

SPEAKER_01 3:24

Yeah. You need to do something about it. You can't just sit there and watch it, watch it ride high and just ravage your body.

Meds Matter But Cost Drives Care

SPEAKER_00 3:30

Yeah. So I I here's what I will say is that I think that if we're gonna start a medicine, traditionally the standard of care is uh start metformin. That's kind of the standard starting medication. And if you fail metformin, you don't tolerate it, get the old uh poopy pants, uh, then you are going to then move on to other medicines. And then eventually, like GLP ones often fall second, third, fourth line because they're expensive. Insurance doesn't want us to spend money on you.

SPEAKER_01 4:02

I was gonna say, I think we should explain why metformin is still the gold, like the first line therapy, and it's because it's cheap, it's well studied, it's long term, and it's been around. So it's been around for a long time. And if people tolerate it, it does work.

SPEAKER_00 4:15

Yeah, so it doesn't work to the uh degree that GLP1s can reduce weight, they have really great cardiovascular kidney benefits. Now, is that because they're uniquely special or because they work so well that you're able to lower sugar and help kind of work on that underlying process? So we just want to make it clear we're not anti-medication.

Diabetes Is Not Inevitable Decline

SPEAKER_00 4:36

Yeah, um, and but there are a couple things that sort of uh grinded my gears in this article, Brian. Uh, and within the article, and I'm pulling it up here on my phone because hey, you know, we're on vacation. So um, they have a big bold sub-headline that type 2 diabetes is naturally progressive. And this is something that will rise my blood pressure even on the shores of Florida at the beach.

SPEAKER_01 5:01

Sounds like we need to get you grounded again, Corey, after this. Yes. So why is that grind your gear so much?

SPEAKER_00 5:06

Because it takes agency away from the individual. It the I can't tell you the number of how times we've been seeing people in our clinic or come into our coaching service that say, Well, my doctor just says I'm gonna have to need more medicines over the course of my life, and that's that. And 50 years ago, we didn't have type 2 diabetes. So the idea that it absolutely, there's like nothing you can do. It's like Austin, like I'm gonna make a 30-year-old movie reference. It's like an Austin Powers when the steamroller is slowly moving towards the guy and ends up rolling him over. But they're making fun of movies like this, but he has like 50 feet where he could just simply move to the side, and you know, Austin Mike Myers' character is like, get out of the way, get out of the way! And the guy's like, no, but it was so this is what it feels like because this guy just needed the tool of move. Yeah, but it kind of paralyzes people into this pattern of just believing, and I boy, our pickleball game this morning. Yeah, I'll I'll make this, I promise I'll make this work, but the first game Brian smoked me.

SPEAKER_01 6:00

No, you were well, yeah, you were winning, and then I came back and smoked you.

SPEAKER_00 6:04

And I I kind of just like I was tired, didn't sleep well, was like, uh making excuses for myself. And I I I just told myself, no more of this. Took some deep breaths, and I decided I would win the next two games, and I did. Oh, he decided, okay. Yeah, he it was a choice. I had no choice, but no, no, you didn't. It was beyond your control. It was like I no, it it's it is such a mindset shift. And the sad thing is that it puts agency in the hands of pharmaceutical companies. And so, and we're not saying big pharma's bad. Again, if you need a medicine, if I had a family member with type 2 diabetes and I had to spin the wheel of medicines and you had to start a medicine, I'd probably go with a GLP1, right?

SPEAKER_01 6:42

I would. And I would make sure they got the lowest tolerable dose, they got titrated appropriately, they got the right lifestyle support with it.

SPEAKER_00 6:49

Yeah, but yes, I agree that I would go with that. Yeah, I mean, this article lists all kinds of benefits: heart health, kidney protection, liver health, sleep apnea, blood pressure, cholesterol, inflammation. So there are real benefits. And the barriers to starting them sooner, I think one, we get in patterns. So prescribers just automatically assume we're gonna start metformin first. So that's sort of the established pattern. But the other barrier is insurance doesn't want to pay for expensive things. If anyone's ever had a car insurance claim or a home insurance insurance claim or a health insurance claim, they don't like paying for stuff, and these are expensive, Brian. So the article is advocating for more coverage so people can start these sooner. And the there are benefits to starting them sooner because it's and it's not just unique to this. If if you improve your sugar earlier in the process of type 2 diabetes, you're also going to reduce the risk of complications. Quick pause for a second. If you're finding the podcast helpful and you want more practical ideas to help move your blood sugar in the right direction, come follow us on Instagram at Diabetes Remission Partners. We share quick tips, food and exercise insights, and blood sugar mistakes people don't even realize they're making. It's also where we can answer your questions directly in the DMs. So if you want more help between episodes, Instagram at Diabetes RemissionPartners is the best place to find us. And when you follow us, make sure to say hi. All right, back to the show.

GLP-1s As A Lifestyle Bridge

SPEAKER_00 8:18

But the other part of me that really bums me out about this is that the article says that you're gonna they're not a quick fix. We agree, right? Yeah, we agree they're not a quick fix. They're meant to be taken long term, even if you reach your A1C and weight loss goals. If you stop taking them, your blood sugar may rise again, and some or all of the weight you lost may come back.

SPEAKER_01 8:37

Yeah, I think that's what we would call management because basically you're letting the medication just do the work and you're not really doing anything to support that. So our philosophy is use medication as a bridge while you're working on lifestyle changes, and then you we quote unquote build this natural medication exit strategy. So you're coming in on medication if you if you're on it, and we're going to work on the skills, the lifestyle habits, the changes that allow you to then safely work your way exit. Like, think of a highway, you're exiting off the highway to get to your destination, and you want to do that collaboration with your doctor, but you're getting off medication, and that's why I don't think it's a long-term solution, right?

SPEAKER_00 9:20

And and so this is the last piece of this article that I want to bring up, and this is we will call ourselves out after I say this thing.

Spot Incentives And Read Critically

SPEAKER_00 9:28

But at the very end, it says this content was made possible with support from Lily, which is a company that makes GLP1 medications. I'm not shocked. No, no, and so if if you're being sponsored by a company, are you ever gonna say anything bad about their product? Probably not. Now, Brian. Speaking of, we're looking for sponsors. Yeah, yeah. Boy, if you if you want so we have no problem with people making a living, but I what we want people to understand is to how to read things critically. Now, Brian, do we have a coaching service that people pay us for? Yeah, we do. Right, we do. So, full disclosure, like we make a living helping people put their type two into remission and reduce their need for medications. And so they have a financial incentive to promote medicines, but we'll be intellectually honest and say, if you're on a GLP one and you feel good and you want to stay on it, great. Like that that's okay. Um, but for the reality that if you need to rely on a medicine that retails at $1,000 a month for the rest of your life, uh, you're at the whims of the insurance company if they'll cover it, you're at the whims of the pharmaceutical company if they can manufacture enough of it. I can't tell you the number of outages of GLP1s. We actually had an emergency episode. Emergency episode was the coverage. So the the reality is we we're here for you regardless of the road you want to take, but we want to provide you the tools to take agency and into your own hands. Listen to episode 61 with Jay from the Gridd Coach talk about agency. He didn't want to be on these medicines, and we're not judging though you if you want to take them. We're we're here to help you. If you take a GLP1 but want still want to need less of it or improve your body composition because the way they work, you can reduce lose muscle on this. We're here to help you. But we can't pretend that there aren't biases out in the world, yeah.

SPEAKER_01 11:12

And I think the the main point here is that if you if you like being if you want to be dependent, if you're if you're someone that doesn't want to be dependent, so I know a lot of people I talk to, they're like, I never saw myself taking medication, and that's just the mindset that people have is that they don't want that. But I'm in I'm a I'm a realist too, in the sense that like some people just need this medication because there's a natural deficiency. So we what we haven't talked about is like GLP1 is naturally in your body, right? Yes, they didn't just make this up, yeah. It's it's a natural occurring peptide in your body. So how does it work? I mean, we don't I'm not gonna get into how it works, but what what else you got in the outline here?

SPEAKER_00 11:55

Because yeah, we're we're we're running running uh on bare minimum uh technology here. So, I mean, really for for us, it's defining the goal and looking at the assumptions. This article assumes that diabetes, type 2 diabetes is chronic, progressive, requires medicine for life. We know what happens when you assume, and we don't like this assumption. But I mean, the goal, obviously, we want to lower sugar, we want to reduce cardiovascular risk, we want to lose weight, we want to build a healthier, stronger body, and reduce medication dependence. So these goals overlap, but they're not identical, right? You can achieve many of these with a medicine, but not all of them. And you can achieve all of these without a medicine. Uh but it is hard work, and it takes investment and time and effort. Uh, and it also takes getting a little bit a little bit angry, I think, at where you're at. And so that's I think a big theme is that we see people who are just fed up with being dependent on medicine and seeing doctors who make these same assumptions that, well, obviously you must be out of medicine for life.

SPEAKER_01 12:49

I'm trying to wrap my head around why they even would say that it's naturally progressive. And the only thing I can think of is like we naturally lose muscle mass uh as we get older. And so in that sense, it would be progressive because muscle is the main primary storage place of sugar for your body. And so, yes, if you're naturally losing muscle as you get older, three to five percent every decade after age 30, and that ex at that that speeds up after age 60, then yeah, I guess I can see how that's naturally progressive.

unknown 13:23

Right.

SPEAKER_00 13:23

But we also see 60 something, 70-something year olds who take A1Cs in the teens and take them to the sixes. Yeah, so that shove that natural progression.

SPEAKER_01 13:32

So and and I was gonna say naturally progressive means like it doesn't mean you can't do anything about stopping that natural progression. But if you do nothing, if you change nothing, even if you took medications that did not stop the progression, like reducing muscle mass, if actually they can expedite it, they can make you lose more muscle mass, then yeah, it could maybe even it can, it can make it can make you more dependent on it, and then it can make your blood pressure go up if you stop it because you didn't actually address blood sugar loss.

SPEAKER_00 14:02

Yeah, and probably blood pressure down.

SPEAKER_01 14:03

And blood pressure goes, that's what I meant.

SPEAKER_00 14:05

Yeah, so no, our blood pressure is up right now. Uh and I think that oftentimes the there's because there's like two camps of people. There's like the medicines will save us camp, and there's the medications or evil camp. And if you've listened to us at all, I think we like to think of ourselves as sort of voices of reason. Yeah. Of there, these are all tools. We can choose the tools, they're not good or bad tools. Uh, you like you especially are against the good versus bad labeling. And and as fun, as far as funding goes, like that's what we're trained as pharmacists to look at when we look at a journal article is who funded this? And and it's not because funding something makes it wrong. Like we have to be able to pay for studies, we have to be, we have to fund things, but incentives influence what gets emphasized. And this article emphasizes staying out of medicine for life, and it's funded by a drug company. I can say that our coaching program is designed to help you stop medicines, and then we say goodbye, congratulations. Yeah, like it's not a lifelong dependence on. There's only there's only one lifelong dependence that each of us have, and it's our poor wives that are stuck with us forever. So uh, and and this applies to everybody big pharma, supplement companies, uh, food companies, influencers, other health coaches. Like we we funding can affect things. Like if we we don't have sponsors yet, uh as Brian said. We're not out here shilling for for sponsors, but if if we came across something that we believed was a great product, we would be incentivized to share it with people. And if they would be incentivized to have people buy it and compensate us for it. So uh but I am I I mean, I think we're pretty not going to be funded by Lily anytime soon, based on our message I wannabe.

SPEAKER_01 15:39

Yeah. But on that note of like sponsorships and products, I do see, and people probably come across this too, those like powders, and I'm always hesitant that anything that the magic supplements, yeah. Well, the supplements that also then are backed by like a little bit of a pyramid scheme where that person's trying to get you to then sell it and then they make more money when they they level up. I'm always a little skeptical of those products because of the incentives behind it.

SPEAKER_00 16:05

Right. And at the end of the day, I we people have to make a living.

SPEAKER_01 16:08

Yeah.

SPEAKER_00 16:09

Um, we and uh you and I have to make a living. We don't have to, we'd like to. Um, but we so anyways.

SPEAKER_01 16:16

I'll argue that we we we want to make a difference. We want to have a we have a purpose and we want to use that, we want to focus that purpose on making a difference in people's lives. That's what we want to do.

SPEAKER_00 16:26

Exactly. So when it comes down to it, we're not anti-GLP1. I hope you can get that from it. Uh we're not anti-medication. And we're but we are uh anti-helplessness. We we hate the feeling of seeing people that feel helpless, and we're anti-believing that progression in type 2 diabetes is inevitable.

If The Drug Disappeared Tomorrow

SPEAKER_00 16:44

And so the question that we want to ask, sort of a thought experiment, Ryan, is if you're on medicine for blood sugar and that medication disappeared tomorrow, what would remain? Would you have more muscle, better habits, a better movement, a healthier environment, or would you simply be waiting for that medication to come back so you could refill the prescription? Yeah, that's a good question. So I I I think that you know, good ideas can come from from parties that have incentives, uh, but good health comes from asking the bigger questions, the bigger questions of what you want, the bigger question of what where you fit in the healthcare system, and the bigger question of what you want life to look like.

SPEAKER_01 17:23

Yeah. Those are the and I think right now a lot of us, I can relate. It's hard to create the space to reflect and ask yourself those questions. And and sometimes it it hurts to listen to the truth about those, like the truth that comes up from the silence. And we talked about like epidemics. We have like a we are a comfort crisis here, and there's also a lack of silence.

SPEAKER_00 17:48

So the comfort crisis is that things are so comfortable that we don't challenge our minds, our bodies, our souls.

SPEAKER_01 17:52

Yeah. And then there's also a lack of silence and reflection time where just there's constant interruption interruptions, distractions, and you don't have to really sit with yourself. But um I think some of the the true hard answers like to that the questions that are gonna change your life are gonna come in those those sil those minutes of silence with yourself.

SPEAKER_00 18:16

So we we hope you got something out of this. We really appreciate the the listener for submitting this uh article to us and asking for our opinion. Uh we don't know what you think of what our opinion is, but um we we enjoyed sharing it. And please keep sending us. I mean, we love these kinds of episodes where we can break down articles, other podcasts, other, you know, any anything out in the world and try to help make sense of it. Because I think that's one thing that we also see is information overload. So we we try to break things down to the the bare minimum effective dose of what you need to know and how to put it into action.

SPEAKER_01 18:48

Yeah. So one takeaway, I think if you see something, look at the bottom, the disclaimer of who sponsors it. Then you'll maybe get a sense of what the incentives are for the information you're reading. Sure. So great. That being said, I'm deciding right now that I'm gonna beat you in pickleball tomorrow.

SPEAKER_00 19:05

Okay, my last day here. Yeah, your last day. You want to send me out on a low note? Yes, I do. So at least we can say we have crushed our children in whiffle ball on the beach. We have. Absolutely crushed. Like physically, emotionally, spiritually, they're uh they leave the beach every night crying. But I think that also has to do that it's like past their bedtime and they're already tired. Yeah.

Share Review And Keep It Simple

SPEAKER_00 19:24

So uh if you if you enjoyed this, share it with someone who needs to hear it. Make sure to rate us, uh, leave us a review. Those really help other people who are struggling with their blood sugar find us. Uh but until next episode when we're back home in our comfy uh separate locations, keep it simple and do what works.

SPEAKER_01 19:40

If this episode gave you clarity or hope, share it with one friend who's been stuck in the diabetes trap. That's how this mission grows. One person, one family, one story at a time. And if you haven't yet, leaving a quick review helps more people find the show and realize they're not stuck with meds forever. It takes less than a minute and it means the world to us. Thanks for being here and thanks for being part of this movement toward freedom. Thanks for listening to the Diabetes Remission Roadmap. The ideas discussed here are for general informational purposes only and do not constitute medical or nutritional advice. We are pharmacists, but we're not your personal health care providers. Always consult your own physician or qualified clinician before changing medications, exercise routines, or nutrition plans. Results vary, and what works for one person may not work for another.