Frequently Asked Questions About Non-Insulin Injectables
1. Q: What are non-insulin injectable treatments for diabetes?
A: There are two classes of drugs that are approved by the Federal Drug Administration (FDA) for type 2 diabetes that are considered non-insulin injectables: Glucagon-like peptide 1 (GLP-1) receptor agonists and amylin analogs. GLP-1 receptor agonists work by mimicking that activity of the naturally-occurring GLP-1 hormone, which stimulates the production of insulin.
Amylin analogs mimic the behavior of another hormone that’s essential in controlling blood sugar levels: amylin. Amylin, like insulin, is released by your pancreas after you eat. People with type 2 diabetes tend to have lower levels of amylin, so amylin analogs are meant to act as the missing hormone – lowering blood sugar, slowing the speed at which food empties from the stomach, and as an added benefit, suppressing appetite.
2. Q: What is GLP-1 therapy for diabetes?
A: Glucagon-like peptide 1 (GLP-1) based diabetes therapy is a type of injectable treatment used by people with type 2 diabetes to stimulate the secretion of insulin, the hormone that keeps your blood sugar from getting too high. While insulin injections replace the insulin your pancreas fails to make, GLP-1 stimulates insulin production if you’re someone who has trouble producing enough of it to keep their blood sugar in check.
Humans naturally produce the GLP-1 hormone in the small intestine. After we eat, the intestine signals the pancreas to make more insulin. GLP-1 likely doesn’t have much of an effect on the average person because it’s degraded, or broken down within two minutes in the human body. But when the GLP-1 hormone is modified so that it doesn’t degrade, as it is with GLP-1 based therapies, it lasts for hours, and becomes a very powerful stimulus of insulin secretion.
3. Q: How do GLP-1 therapies work?
A: In addition to stimulating insulin, GLP-1 suppresses glucagon, a hormone that releases glucose from the liver into the bloodstream thereby increasing blood sugar. In other words, glucagon is the anti-insulin hormone. By stimulating insulin secretion (which lowers blood sugar) and suppressing glucagon (which prevents an increase of glucose being released into the bloodstream), GLP-1 based therapies effectively lower blood sugar.
GLP-1 also slows the stomach’s contents as they are emptied into the intestines, and as a result, regulates how quickly large glucose concentrations are being absorbed after meals. Finally, GLP-1 therapies tend to decrease appetite, so they can also help as a weight loss agent for people with type 2 diabetes who are severely overweight.
4. Q: When are GLP-1 based therapies the best treatment option for diabetes?
A: Typically, we’ll start someone with type 2 diabetes on oral medications. If the oral medications fail to control blood sugar levels, we’ll consider switching to either insulin injections or GLP-1 (non-insulin) injections. Which one we go with varies from person to person. For instance, if you’re severely overweight, it would make sense to start you on GLP-1 injections, since they suppress appetite. In cases where you still have the ability to produce some insulin on your own, we might start with GLP-1 to stimulate more insulin production before jumping right to insulin injections.
We’ll also look at the A1C level. The A1C, or the glycated hemoglobin, is a running average of your blood sugar levels over the past three months. People without diabetes typically have an A1C level less than 6%. If your diabetes is well-controlled, your A1C should be under 7%. However, if your A1C starts to get close to 10%, we’ll probably start you on insulin. If you have symptoms that would indicate severe insulin deficiency or severe high glucose, such as: weight loss, polyuria (production of large volumes of diluted urine), polydipsia (abnormally high thirst) and muscle weakness -- we’ll likely start you on insulin right away.
THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.
Adrian Vella, MD, is a professor of medicine at
the Mayo Clinic College of Medicine in Rochester, MN. He
is certified by the American Board of Internal Medicine for Endocrinology,
Diabetes and Metabolism, and has been practicing endocrinology since 2001. View his Healthgrades profile >
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