糖尿病用藥GLP-1 RA類，對於低血糖的副作用相對的非常少，到底是甚麼緣故呢？

很多人問到關於GLP-1 RA的使用上，對於低血糖的副作用相對的非常少，到底是甚麼緣故呢？

根據美國糖尿病醫學會的這篇文獻來看，可以發現不論是原生的GLP-1或是GLP-1 RA，都可以雙向的刺激或是抑制α細胞，進而調控昇糖素。

也因此當血糖濃度較高時，會抑制α細胞，減少昇糖素分泌，同時刺激β細胞，增加胰島素分泌。

當血糖濃度較低時，則顛倒過來，變成刺激α細胞，增加昇糖素分泌，同時減少刺激β細胞，減少胰島素分泌。

如此一來幫助達到良好血糖控制，也不容易造成低血糖問題。


​GLP-1 (via GLP-1R in α-cells) plays a bidirectional role, either stimulatory or inhibitory, in glucagon secretion depending on glucose levels.

GLP-1（透過阿發細胞中的GLP-1R）根據血中葡萄糖濃度調控昇糖素分泌達到刺激或抑制作用
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GLP-1 RA (包括 liraglutide, semaglutide, dulaglutide, 及 albiglutide)

​更詳細內容 於專業人員區。
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資料來源：GLP-1 Receptor in Pancreatic a-Cells Regulates Glucagon Secretion in a Glucose-Dependent Bidirectional Manner

Isolated islets from αGLP-1R−/− mice show abnormal glucagon secretion in response to glucose. Islets were isolated from female mice, 3–4 months old, and used in these experiments. Shown are average data from at least three independent assays, which involved 8–10 mice/group. A: GSIS assay of islets isolated from the KO (ko) and WT (wt) mice. Low (L) glucose: 2.5 mmol/L; high (H) glucose: 16.5 mmol/L. B: The stimulation index (S.I.) of GSIS, which was calculated by dividing the insulin concentration at high glucose by that at low glucose. C: Arginine (Arg)-stimulated glucagon secretion assay, which used 20 mmol/L arginine and 100 nmol/L exendin9-39 (Exe9-39). D: Stimulation indexes for glucagon by arginine, exendin9-39, and both arginine and exendin9-39. Glucagon (E) and insulin (F) secretion in response to glucose levels of 2.5 mmol/L, 5 mmol/L, and 10 mmol/L. *P < 0.05; **P < 0.01.