Friday, July 6, 2012

What is GPL-1 ?

What is GPL-1 (Glucagon like peptide -1 )

Type 2 Diabetes is a complex game with many players.
Most of us are aware of  Beta cell dysfunction and failure causing insulin deficiency and we are familier with the term insulin resistance and its association with weight gain and obesity.
 We are less familier with the dysfunction of the pancreatic alpha cells and inappropriate Glucagon release triggering the liver to release glucose resulting in higher fasting and after meal glucose levels 

The , newest member of  this group  , is a deficiency of a hormone made in our intestine, Glucagon like Peptide -1 (GPL-1 ). 
This hormone is released in response to eating and has a powerful influence on our ability to manage  blood glucose levels.

Effects of GPL-1
 #1  Glucose - Dependent insulin secretion. This hormone allows insulin secreting Beta Cells to 
        produce insulin in response to an increase in glucose levels.
  #2  Decreases glucagon levels resulting in lower fasting and after meal glucose levels
  #3   Appetite suppression and Slows  gastric emptying

Products Available to replace GLP-1 deficiency

GLP-1 agonist
 Exenatide ( Byetta )     a twice daily injection
 Liraglutide ( Victoza )  one injection per day
 Exenatide ( Bydureon ) weekly injection

Chart summary
                                        GLP1 agonist      DPP4 inhibitors    acarbose   Insulin    sulfonylureas

Effectively reduce A1c           YES                      YES                  YES       YES          YES

Preserve Beta cell function    YES                      ?                       NO        NO            NO

Promotes weight loss             YES                      No                     + -          NO            NO

Promotes weight gain              NO                      NO                     + -         YES           YES

Do not cause hypoglycemia   YES                     YES                   YES        NO            NO

Once a week injection             YES                     NO                     NO          NO           NO

Glucagon suppression            YES                     YES                   NO         NO           NO

Most expensive                         YES                        +-                     NO          + -            NO

Tomorrow I will review DPP-4 inhibitors.

Have Fun , Be Smart  and take advantage of the wonderful new medications available for treating type 2 diabetes
 David Calder,MD

1 comment:

  1. I have been on Byetta for 3 years this fall. I have lost weight, my A1c has dropped to 6.1 and my BSs are lower - much lower. I exercise 4 times a week, eat pretty much as I already had been and exercise the same - I attribute the lowering of weight and blood sugar and A1cs to the Byetta. I feel great and I look great at 64.


Your comments and questions are appreciated. David Calder,MD