Diabetes Treatment (cont.)
New medications that affect glycemic control
Symlin (pramlintide)
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.
Next: DPP-IV inhibitors »
- ACE Inhibitors - Read about ACE inhibitors like Altace, lisinopril, enalapril, ramparil, Zestril and more. Information includes side effects, drug interactions, and pregnancy safety information.
- Hemoglobin A1c Test - Hemoglobin A1c test is used as a standard tool to determine blood sugar control for patients with diabetes
- Diabetes - Learn about type 1 and 2 diabetes (Diabetes Mellitus) symptoms including increased urination, thirst, weight loss, fatigue, nausea, vomiting, skin infections, and blurred vision. Causes and diagnosis information is provided in the information.
Latest Medical News
Diabetes RSS