The Latest in GLP-1 Therapy

January 22, 2015

By Kristen Rider, BSN, RN, CDE

GLP-1 agonist medications are a common treatment for the management of Type 2 Diabetes. They work like the hormone GLP-1 (Glucagon-like peptide 1) that the body normally produces to help regulate blood glucose levels. People with Type 2 Diabetes may be deficient in GLP-1, which is why these medications are being used. GLP-1 agonists work to control blood glucose levels by decreasing the amount of glucose that the liver produces, delaying gastric emptying time, and helping the pancreas to produce more insulin when blood glucose levels are high. The first to hit the market was Byetta in 2005. Since then, several others have been launched, some within the past few months. All of the GLP-1 agonist medications are injectable, but each has a different device or mechanism for injection. Dosing varies from twice daily, daily, to once weekly. Some of these medications are FDA approved for use in conjunction with basal insulin, while others were not studied as such. See the comparison chart below for more information on GLP-1 agonists.

Drug Dose Mixing


Pre-injection waiting time


Approved for use with basal insulin


Twice daily



5mcg, 10mcg


Bydureon Kit


Once weekly Yes No

2 mg

Bydureon Pen
Once weekly Yes No 2 mg



Once weekly


Yes 15 min

30mg       50mg




Once weekly



0.75 mg




Once daily

No No 0.6mg


1.8 mg


Package Insert (PI) list

Byetta (exenatide) AZ – Bydureon Pen and Kit (exenatide extended release) AZ – Tanzeum (albiglutide) GSK – Trulicity (dulaglutide) LILLY – Victoza (liraglutide NOVO –

This information is not meant to replace your healthcare Provider’s advice. It is not an endorsement of these products or of the pharmaceutical companies. The Outpatient Diabetes and Nutrition Services Department at St. Anthony’s Medical Center can assist you with questions you may have regarding this change or other questions you have regarding your diabetes self-management. Call us at 314-525-4523 for more information.



New Levemir Insulin Pen Delivery Device

September 11, 2014

Submitted by Kristen Rider, BSN, RN, CDE

NovoNordisk has launched the new insulin pen delivery device for Levemir insulin. Previously, Levemir was available in a vial or in a Flexpen. The new pen device is called the Levemir FlexTouch Pen. The new pen device now has no push-button extension. On the previous device, as the dose was dialed, the push button extended outward. The FlexTouch has a low-force touch button and a click after the dose is delivered. The new device can deliver up to 80 units in one dose (previously 60 with the Flexpen). Each pen device is prefilled with 300 units of insulin, as it was previously with the Flexpen. If you use a Levemir Flexpen, you will be seeing the new device in the near future, as the Flexpen will be discontinued. Levemir will continue to be available in a vial.

This information is not meant to replace your healthcare Provider’s advice. It is not an endorsement of this product or of the NovoNordisk company.

The Outpatient Diabetes and Nutrition Services Department at St. Anthony’s Medical Center can assist you with questions you may have regarding this change or other questions you have regarding your diabetes self-management. Call us at 314-525-4523 for more information.


Source: NovoNordisk, 2014

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


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.

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