Monday, February 13, 2012

New Medications- High Cost- Hypoglycemia to the Rescue

Managing diabetes over the years generally involves the use of a number of medications to control glucose , lipids and blood pressure. Improving your understanding of these very potent amazing medications  is important to your success in defeating diabetes.

Today our discussion is about some of the newer medications with unusual names.

Most of the these new medications are altered forms of hormones and enzymes that are working in our bodies every day. I will start by reviewing the sources on these hormones  in our body.

Pancreas - Beta Cells --Insulin --     allow glucose use in our tissues and regulate fat metabolism
                                       Amylin--     slows stomach emptying, promotes a feeling of fullness, inhibits
                                                           glucagon release

                 Alpha cells -Glucagon-   regulates the release of glucose from our liver

Intestine  - produces -  GLP 1 -       Slows stomach emptying
                                                           Stimulate glucose sensitive insulin release and restores early rapid
                                                           insulin release
                                                           Inhibits glucagon release
                                                           Preserves Bets cell function and slows the damage  to Beta cell
                                                           Promotes  the development of new Beta cells
                                                           Promotes weight loss

 Blood  -   Enzyme -         DPP-4 -    Destroys GLP -1 causing  GLP -1 to have a very short life span .
                                                            One half of GPL-1 is destroyed every 2 minutes

Non - Diabetic
 eating a piece of bread  >  glucose  absorbed - Beta cells release insulin  and Amylin > normal glucose
                                                      Intestine releases   - GLP-1
                                                      Alpha cells decrease glucagon release
                                                      DPP-4 destroys GLP-1

A person with Diabetes has a dysfunction of almost all of the above systems.

Eating a piece of bread  >   glucose is absorbed - beta cells sluggish or no insulin      > high glucose
                                                       Intestine releases inadequate amounts of GLP-1
                                                       Alpha cells continue to release glucagon
                                                       DPP-4 destroys the released GLP-1

 A fresh look at some of these amazing new medications.

   GLP -1  agonist  -   replaces the deficiency of a normal hormone in our body

   DPP-4 inhibitors  - interferes with the enzyme that is destroying GLP- 1 allowing it to last longer         
   Amylin                 -  Replaces  the deficiency of amylin

 Drug names of the above medications
  GLP-1 agonist                                                  DPP-4 Inhibitors                    Amylin
      Byetta ( exenatide )                                           Januvia ( sitagliptin )                Symlin( pramlintide)
      Bydureon ( exenatide slow release )                 Onglyza ( saxagliptin )             Symlinpen
      Victroza  ( liraglutide )                                      Tragenta (linagliptin )

      It seems that the most logical choice of medications for a person with Type 2 Diabetes would be a combination of Glucophage and a GLP-1 agonist. The cost of taking a GLP-1 agonist is a big deterrent blocking the more wide spread use of this combination. Another deterrent is caution in using any new medication because significant side effect may not show up for years after millions of people are using the medication. However the biggest immediate problem is cost.

      Believe it or not hypoglycemia may be coming to our rescue. See tomorrows discussion for details.

" It is more fun to prevent complication than it is to treat complications"
   David Calder, MD

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Your comments and questions are appreciated. David Calder,MD