Move Over, Insulin: Another Hormonal Treatment for Type 2 Diabetes?

June 18, 2013

When you think of treatments for diabetes, what comes to mind? Maybe oral medications like metformin or glipizide? Injectable insulin?  Hopefully diet and exercise are frontrunners, but what about hormones? Sure, insulin is a hormone, so maybe that doesn’t seem so odd, but what about a hormone that can actually increase the number of cells which make insulin?

Insulin is produced in the pancreatic beta cells.  It serves as a “key” to unlock our cells so they are able to take in energy (aka our blood glucose). The diagram below shows the progressive response of the body to insulin as diabetes progresses. 

Insulin Diagram

In type 2 diabetes, our cells become resistant to insulin, which causes our pancreas to pump out more and more in response. Eventually, this can lead to exhaustion of our healthy beta cells, which can stop working all together (or produce too little insulin for us to use effectively). Once the body cannot make enough insulin, our blood sugars are consistently elevated, and we may need to start using injectable insulin. Researchers at the Harvard Stem Cell Institute have found that when livers in mice were programmed to secrete more of the hormone betatrophin, the number of beta cells in the mice increased threefold. Researcher Doug Melton states, “We would provide this hormone, then the type 2 diabetic will make more of their own insulin-producing cells, and this will slow down, if not stop, the progression of their diabetes.” Unfortunately, the researchers do not believe that this would impact how type 1 diabetes is treated.

Of course, there will be a long testing process before your doctor will be able to prescribe this as a treatment. It will first be tested on mice with diabetes, and only if positive results are seen will testing move to human subjects. In the meantime, another way to manage your type 2 diabetes (without a prescription) involves decreasing our resistance to insulin. This can include eating a controlled and consistent amount of carbohydrates (one of the macronutrients, along with protein and fat, which can be found in grains, starches, fruits, and dairy products, along with sweetened and dessert-type foods), staying active through exercise, and maintaining a healthful weight. Not sure where to start? Your dietitian can determine an appropriate individualized meal plan for weight management.  

Written by: Kelly Houston, Saint Louis Dietetic Intern

Resources:
http://diabetes.ufl.edu/2013/04/26/betatrohpin-could-help-manage-diabetes-better-new-study-finds/


New diabetes medication hits the market

February 22, 2012

As we continue to learn more about type 2 diabetes, researchers are finding new ways to treat it. Type 2 diabetes in some ways can be more complex than type 1, in that there are many factors causing blood sugar to be elevated: insulin resistance of the body’s cells, decreased insulin secretion by the pancreas, overproduction of glucose from the liver, improper timing of gut hormones and, the newest find, over-reabsorption of glucose in the kidneys.

This is why there are so many different drugs used to treat type 2 diabetes! Using multiple medications for diabetes treatment does not necessarily mean that your diabetes is “worse.” I like to think of it as treating many different facets of diabetes in order to improve blood sugar control.

You may have heard of, or be taking, Byetta.  Byetta (exenatide) is an injectable medication in the class called GLP-1 receptor agonists or “incretin mimetics.”  Byetta is given 30-60 minutes before 2 meals a day, usually breakfast and dinner, and performs many functions:

  • Slows gastric emptying (how fast your stomach digests food)
  • Increases satiety (feeling of fullness after a meal)
  • Increases insulin production, but only in the presence of glucose
  • Decreases glucose production by the liver
  • Helps promote weight loss

Now there’s a new GLP-1 receptor agonist that performs the same functions as Byetta, except it is available in a once-weekly, long-acting injectable dose. It’s called Bydureon (a long-acting form of exenatide). Even though Byetta and Bydureon are injectable medications, they are not insulin.

If you have type 2 diabetes and you’re having trouble controlling blood sugars, Bydureon could be a good option for you because you only have to take it once per week, versus twice per day. Side effects include symptoms of nausea, vomiting and sometimes diarrhea (even more prominent than with Byetta). Nausea is a common side effect of both Byetta and Bydureon–in fact this is one of the reasons these medications are used. They help people learn to stop eating when satisfied and prevent overeating. Overeating when taking Byetta or Bydureon typically increases symptoms of nausea. Both Byetta and Bydureon are not recommended as the first treatment for type 2 diabetes and should be used in conjunction with diet and exercise. Talk to your doctor to find out if a GLP-1 receptor agonist might be right for you.

There are some serious warnings related to taking Bydureon. You will find that both Byetta and Bydureon carry warnings of thyroid tumors and medullary thyroid cancer (MTC); which developed in animal studies. It is advised that people  with a history or family history of MTC not take Bydureon. Bydureon also increases your risk for acute pancreatitis. It is advised that you tell your doctor if you have had pancreatitis, gallstones, high triglycerides or a history of alcoholism prior to starting Bydureon.

For more information about Bydureon, click here. If you feel like your diabetes care plan isn’t working as you’d like, also consider meeting with a Diabetes Educator or Registered Dietitian.

Photo credit: posterize


New dosing guidelines for Tylenol containing products

December 30, 2011

Today, more than 600 over-the-counter (OTC) and prescription (Rx) medications contain acetaminophen (Tylenol). Some people accidentally exceed the recommended dose when taking multiple acetaminophen-containing products at the same time, often without realizing they contain acetaminophen or by not reading and following the dosing instructions.

McNeil Consumer Healthcare (McNeil), the makers of TYLENOL® is leading the industry in implementing new steps designed to lessen the possibility of accidental acetaminophen overdose and help ensure that people who use TYLENOL®, and other products containing acetaminophen, use them appropriately. As one step toward that goal, on December 19, McNeil voluntarily introduced new dosing instructions for single-ingredient Extra Strength TYLENOL® sold in the United States.

The revised dosing instructions on the OTC label for Extra Strength TYLENOL® (500mg size) reflect the following changes:

Take 2 caplets (1,000 mg) every 6 hours while symptoms last
(revised from 2 caplets every 4 to 6 hours).
Not to take more than 6 caplets (3,000 mg) in 24 hours, unless directed by a doctor
(revised from 8 caplets in 24 hours).
The Warnings section will be modified to reflect the new daily dose.
Specifically, the liver warning on the OTC label will continue to state that severe liver damage may occur if more than 4,000 mg of acetaminophen is taken.

For people whose pain or fever recurs despite the administration of a total daily dose of 3,000 mg, it is recommended that a Physician or health care Provider should be consulted. If you are not sure if some of the routine medications you take contain acetaminophen, check with your local Pharmacist before adding an over the counter product. For your safety, carry a list of all medications, prescribed or OTC, and supplements that you take and share that list with any Physician or Specialist that you see.


Got Drugs?

October 27, 2011

The U. S. Drug Enforcement Agency, in conjunction with state and local law enforcement agencies, is conducting another National Prescription Drug Take Back Day on Saturday, October 29, 2011 from 10:00 a.m. to 2:00 p.m. During this event anyone can safely dispose of unwanted and unused prescription medications. This initiative helps to address the public health issue associated with abuse of prescription drugs. Studies have revealed that the majority of prescription drugs that are abused are obtained from friends, family and the home medicine cabinet.

There are many designated locations in the St. Louis metropolitan, bi-state area. For more information about the National Take Back Initiative and to find a collection site near you visit this site and enter your zip code.


All metformin products not created equal?

October 11, 2011

Our clinical staff has recently received inquiries regarding the medication products that contain Metformin. As this is a very commonly used diabetes medication and there are various forms of available, I wanted to share the information with you.

Metformin was introduced in Europe in the 1950′s and the Food and Drug Administration (FDA) approved its use in the U.S. in December 1994. In general, metformin products:

  • Decrease the amount of glucose released by the liver
  • Decrease intestinal absorption of glucose
  • Improve insulin sensitivity
  • Improve glucose utilization in skeletal muscle and adipose tissue.

The main differences in the various products involve the chemical coating of the products and their location of action. Click here for more detailed information on the specific functions of different metformin products. If you have questions about the metformin product you take, contact your physician or diabetes educator. Please share any concerns or questions with our staff.


LIVE: Mapping your journey for diabetes control

July 7, 2011

Come join us for an interactive TalkDiabetes LIVE program, Continuing Your Journey with Diabetes.  We’ll use “conversation maps” to guide discussion on the ABC’s of diabetes, short and long-term complications and goal setting.  Our Certified Diabetes Educators will also present information on new diabetes medications that can help in your journey for diabetes control. The free presentation is scheduled for 7 p.m. on July 21 in the Great Room at the Hyland Education & Training Center, 10020 Kennerly Road, on the campus of St. Anthony’s.  Please register by calling 314-ANTHONY. We hope to see you there! 

The TalkDiabetes LIVE meetings have replaced our diabetes support groups.  Same state-of-the-art information, interesting programs and free samples–just a different name!


New med approved for type 2

June 28, 2011

On May 2, 2011, Tradjenta (linagliptin) was approved to be used along with diet and exercise for the treatment of type 2 diabetes. Tradjenta belongs to the class of drugs called DPP-4 inhibitors.  DPP-4 inhibitors work by blocking the enzyme DPP-4, which increases the availability of gut hormones called incretins.  Incretins help increase insulin production, decrease release of glucose from the liver and delay gastric emptying (helping you to feel full faster).  Overall, this action leads to better glucose control—using Tradjenta may help lower A1c up to 0.6%. This medication is given in a 5mg tablet once a day. Tradjenta increases the risk of hypoglycemia (low blood sugar) if you are also taking sulfonylureas or insulin. Tradjenta is similar to other drugs in the DPP-4 class, Januvia and Onglyza.  For more information, visit www.tradjenta.com.  Talk with your doctor if you think Tradjenta might be right for you.


Spring clean your medicine cabinet

April 25, 2011

Safe disposal of medication is a key to maintaining health.

Our spring cleaning “adventure” continued this week as we started cleaning out the cabinets in our office.  It started off as a daunting task, but discarding unnecessary supplies, reorganizing the remainder and ending up with new space is so refreshing!  If you’re continuing with your spring cleaning, you might wonder what to do with old, expired medical supplies.  We’re often asked, “What is the right way to dispose of  expired medications?”

Medications – prescribed, over-the-counter, and/or herbs and supplements – can play an important role in treating certain conditions or diseases.  However, medications and testing supplies cannot be thrown out like everyday garbage: they must be taken with care and disposed of safely. 

Unused portions of medications must be disposed of properly to avoid harm to people, pets, and the water supply.  Most should not be flushed down the toilet.  Make sure to follow specific disposal instructions on the drug label or product insert.  If no disposal instructions are given, follow these steps.

Don’t forget about glucose testing supplies and insulin. Certain brands of glucose test strips may not give an accurate reading if opened for more than 90 days.  The expiration date printed on the test strip label is valid only if never opened.  When you open a container of strips, use a permanent marker to write the date on the label so you’ll know how much time has passed.  Insulin products also have time limitations ranging from 14 to 42 days, depending on the particular type of insulin and if dispensed in a pen device or vial.

If you have additional questions, the instructions inside the product packaging or your pharmacist can give you storage information for medications and supplies.  Safety is key to helping you stay healthy!

Written by: Nancy Trebilcock, RN, BSN, CDE


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