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
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
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