If the oral diabetes medication you’re taking isn’t getting your HbA1c into a healthy range, your doctor may suggest a combination therapy that also includes injectable insulin or an injectable medication. Which medications you wind up using depends on your preference and medical history.
The goal for medication therapy of type 2 diabetes is generally an HbA1c of less than 7%. However, your health care provider will determine your HbA1c goal based on individual factors.
Here is an overview of the classes of non-insulin injectable medications currently available:
How they work: reduce glucagon levels which helps to reduce blood glucose levels.
Name: pramlintide (Symlin)
Benefits: helps with weight loss, helps slow the rise in blood glucose levels after a meal.Injected before you eat. Frequent dosing schedule and training requirements considered a drawback.
During digestion, pancreatic beta cells release not only insulin, but in a much smaller amount, the hormone amylin, which helps mediate sharp rises in blood glucose levels following meals. Pramlintide (Symlin) is a new, synthetic form of amylin that may help improve blood glucose control for some type 1 and type 2 diabetic people who use insulin. Pramlintide has few side effects (nausea is the main one) but it adds another set of injections to a diabetic person’s daily pharmaceutical routine, as it cannot be mixed in the same syringe with insulin.
2.GLP-1 Receptor Agonists
How they work: Increase insulin production, decrease sugar made in the liver, decrease food intake.
Names: exenatide (Byetta); liraglutide (Victoza); dulaglutide (Trulicity); albiglutide (Tanzeum).
Benefits: Helps with weight loss. Decreases some cardiovascular risk factors. Helps slow the rise in blood glucose levels after a meal. Infrequent dosing. Once-a-week dosing now available. Contraindicated in people with ketoacidosis or severe kidney problems.
Another non-insulin injection for people with diabetes is exenatide (Byetta). This medication, originally derived from a compound found in the saliva of the Gila monster, triggers insulin release from the pancreas when blood glucose levels rise.
The development of effective GLP-1 receptor agonists started with a discovery made by a scientist studying venom peptides found in the the saliva of a large lizard!(Gila monster).
Venom is an incredibly rich source of bioactive molecules, and scientists around the world are studying the venom of a bewildering array of animals in order to identify everything from better painkillers to therapies for Parkinson’s disease.
Exenatide is meant to be used along with oral diabetes drugs. It is dosed twice daily and should be injected within an hour of the morning and evening meals.
Recently, the FDA warned that exenatide may increase the risk of severe even fatal pancreatitis (inflammation of the pancreas) and that the drug should be discontinued and not restarted if signs and symptoms of pancreatitis develop (severe abdominal pain, for example).
It is not for use in people with type 1 diabetes.
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