Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Pramlintide (Symlin) is the first in a new class of injectable, anti-hyperglycemic
medications for use in patients with type 2 or type 1 diabetes treated with
insulin. Pramlintide, the active ingredient in Symlin, is a synthetic analog of
human amylin, a naturally occurring
neuroendocrine hormone synthesized by
pancreatic beta cells that helps control glucose control after meals. Amylin,
similar to insulin, is absent or deficient in patients with diabetes. When used
with insulin, this compound can improve glycemic control and has additional
benefits that cannot be realized with insulin alone.
According to published data, Symlin reduces post meal blood sugar peaks,
reduces glucose fluctuations throughout the day, enhances satiety (the sensation
of fullness) leading to potential weight loss, and lowers mealtime insulin
requirements. Studies have shown it improves A1C beyond the effect of insulin
alone.
Symlin is taken just prior to meals, three times a day. It is given in
injection form and is used for:
Type 2 diabetes, as an additional treatment in patients who use mealtime
insulin therapy and have failed to achieve desired glucose control despite
optimal insulin therapy, with or without a concurrent sulfonylurea agent and/or
metformin.
Type 1 diabetes, as an additional treatment in patients who use mealtime
insulin therapy and who have failed to achieve desired glucose control despite
optimal insulin therapy.
Symlin is considered a therapy option in patients with insulin-using type 2
or type 1 diabetes, that are unable to achieve adequate glycemic control despite
individualized insulin management. Insulin-using patients with type 2 diabetes
may also be taking a concurrent sulfonylurea agent and/or metformin.
The major side effect of Symlin is
nausea, and this can be
reduced with a slow, steady, increase in dose. The other major side effect is
hypoglycemia (dangerously low levels of blood sugar). To avoid this, the dose of
mealtime insulin should be cut in half when starting Symlin. Of note is the
degree of weight loss seen with Symlin therapy. Studies for up to six months
show weight loss of greater than six pounds more than placebo (inactive pills).
Byetta (exenatide)
Exenatide (Byetta) is a medication on the market that has it's origins in
an interesting place--the Gila monster's saliva. Scientists studying this small
lizard noted it could go a long time without eating. They found a substance in
it's saliva that slowed stomach emptying, thus making the lizard feel fuller
longer. This substance was similar in nature to a gut hormone found in humans
known as GLP-1. GLP-1 is broken down in the body by an enzyme called DPP-IV. So,
if you could make a substance like GLP-1 that was not so easy to breakdown, this
would have potential benefit; thus, the studies began. Ultimately, after
modifying this hormone, exenatide (with the trade name Byetta) was developed.
Byetta is the first in a class of drugs for the treatment of type 2 diabetes
called incretin mimetics. Byetta has been shown to have many of the same effects
on sugar regulation as GLP-1, so it mimics the body's natural physiology for
self-regulating blood sugar. Namely, it slows the release of glucose from the
liver, slows stomach emptying thereby regulating delivery of nutrients to the
intestine for absorption, and works centrally in the brain to regulate hunger.
Byetta is indicated as additional therapy to improve control of blood sugars
in patients with type 2 diabetes who are taking metformin, a sulfonylurea, or a
combination of metformin and a sulfonylurea but who have not achieved adequate
sugar control. It enhances the way the insulin producing beta cells in the
pancreas work. Insulin secretion increases only when blood sugars are high and
decreases as blood sugars approach normal. In addition to enhancing the normal
physiology of the beta cell, Byetta suppresses glucose release from the liver,
slows stomach emptying and the absorption of nutrients including carbohydrate,
and reduces intake of food.
Just like Symlin, Byetta is given by injection, but it is given twice a day
(usually before breakfast and dinner meals). It comes in a disposable pen form
and is available in two doses. The goal is to start with the lower dose for a
month or so and then move up to the higher dose if needed and if tolerated.
Similar to Symlin, the main side effect is nausea, most likely due to its
effects on stomach emptying. This medication is temperature sensitive and it was
recommended that the pens be stored at 36 to 46 F (2 to 8 C).
Recently, this has
changed, with a recommendation that unopened pens be refrigerated, and once
opened, the pens can be left at room temperature. The risk of hypoglycemia is
still a possibility with Byetta, especially when used in combination with
sulfonylureas. Your physician may choose to decrease the dose of some of your
other medications when initially evaluating how you respond to Byetta.
Similar to Symlin, weight reduction is seen with Byetta in the majority of
patients. This makes it particularly suitable for the typical patient with type
2 diabetes who is also overweight.
A longer acting from of Byetta is currently being considered for approval by
the FDA. This would allow for the same benefits (and side effects) without need
for such frequent injections.
Victoza (lyraglutide)
Victoza (lyraglutide) is an injectable prescription medicine that improves blood sugar (glucose) in adults with type 2 diabetes when used with a
diet and exercise program. Victoza is not insulin. It is not known if Victoza is safe and effective when used with insulin. Victoza is not for people with type 1 diabetes or people with diabetic ketoacidosis. Victoza is not recommended for use in children.
Victoza, like Byetta, belongs to a class of medicines known as glucagon-like peptide-1 (GLP-1) receptor agonists, which help the pancreas make more insulin after eating a meal.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Hypoglycemia is a syndrome caused by low blood sugar. Symptoms of hypoglycemia include palpitations, trembling, intense hunger, sweating, nervousness, and weakness. Consuming lifesavers, table sugar, soda, and juice are good treatment options for hypoglycemia.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include: intermittent claudication, rest pain, numbness in the extremities, and more. Treatment for peripheral artery disease include: lifestyle measures, medication, angioplasty, and surgery.
Hyperglycemia is a serious health problem for diabetics. There are two types of hyperglycemia, 1) fasting, and 2)postprandial or after meal hyperglycemia. Hyperglycemia can also lead to ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). There are a variety of causes of hyperglycemia in people with diabetes. Symptoms include increased thirst, headaches, blurred vision, frequent urination and more. Treatment can be achieved through lifestyle changes or medications changes. Carefully monitoring blood glucose levels is key to prevention.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
Radiculopathy, a condition in which a nerve or nerves along the spine are compressed causing pain, numbness, weakenss, and tingling along the nerve(s). Some causes of radiculopathy include bone spurs, disc hernation, osteoarthritis, tumors, infection, and neuropathy. Treatment depends on the are of nerve compression. Surgery is generally not required.
Orthostatic hypotension symptoms include lightheadedness, weakness, blurred vision, and syncope or passing out. Causes of orthostatic hypotension include dehydration, anemia, medication, blood loss, low blood pressure, heat related illnesses and more. Treatment of orthostatic hypotension depends on the underlying cause.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
A diabetic diet, or diabetes diet helps keep blood glucose levels in the target range for patients. Exercise and medication may also help stabilize blood glucose levels. Keeping track of when you take your diabetic medicine, keeping track of food choices, eating the proper amount of fruits, vegetables, carbohydrates, and fats will also help maintain proper blood glucose levels.
Diabetes-related foot problems can affect your health with two problems: diabetic neuropathy, where diabetes affects the nerves, and peripheral vascular disease, where diabetes affects the flow of blood. Common foot problems for people with diabetes include athlete's foot, fungal infection of nails, calluses, corns, blisters, bunions, dry skin, foot ulcers, hammertoes, ingrown toenails, and plantar warts.
Prader-Willi syndrome is a condition characterized by severe floppiness (hypotonia), poor growth, delayed development, and poor feeding problems in early infancy later followed in infancy by excessive eating that may lead to extreme obesity. The genitals in both females and males are underdeveloped and most are infertile. Prader-Willi syndrome is related to chromosome 15.
The risks for developing type 2 diabetes include family history, ethnicity, birth weight, metabolic syndrome, and obesity. Warning signs pointing to an increased risk for developing type 2 diabetes include irregular menstruation, impaired fasting glucose, inflammatory markers, and other risks. Gestational diabetes is also a risk factor for developing type 2 diabetes later in life. Prevention of type 2 diabetes can be achieved through a healthy diet (Mediterranean diet), exercise, weight control, not smoking, and medication.
In the United States diabetes is the most common cause of kidney failure. High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will eventually progress to kidney failure. Kidney disease in people with diabetes develops over the course of many years. albumin and eGFR are two key markers for kidney disease in people with diabetes. Controlling high blood pressure, blood pressure medications, a moderate protein diet, and compliant management of blood glucose can slow the progression of kidney disease. For those patients who's kidneys eventually fail, dialysis or kidney transplantation is the only option.
Diabetes and eye problems are generally caused by high blood sugar levels over an extended period of time. Types of eye problems in a person with diabetes include glaucoma, cataracts, and retinopathy. Examples of symptoms include blurred vision, headaches, eye aches, pain, halos around lights, loss of vision, watering eyes. Treatment for eye problems in people with diabetes depend on the type of eye problem. Prevention of eye problems include reducing blood pressure, cholesterol levels, quitting smoking, and maintaining proper blood glucose levels.
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
Having diabetes can mean early onset and increased severity of bladder symptoms (urinary incontinence and urinary tract infections) and changes in sexual function. Men may have erectile dysfunction; and women may have problems with sexual response and vaginal lubrication. Keep your diabetes under control, and you can lower your risk of sexual and urologic problems.
Taking care of a disease such as diabetes is a life-long process. Learn how to care for yourself or loved one with diabetes in situations such as illness, work, school, travel, or a natural disaster.
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