The Pros and Cons of Non-Insulin Injections for Diabetes

By

Pat F. Bass III, MD, MS, MPH

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Understanding Non-Insulin Injectable Therapies for Diabetes

Some patients could greatly benefit from these non-insulin injections options.
Japanese doctor talking to patient

If you have type 2 diabetes that’s not adequately controlled with diet and lifestyle changes, your health care provider is likely to start you on a single oral medicine such as metformin.

However, it’s not uncommon for you to require additional therapy to reach your diabetes goals. Non-insulin injectables are an option for your diabetes management as an add-on therapy either before or after insulin treatment.

Type 2 diabetics should check their blood sugar before and after every meal to make sure their levels are within a healthy range. In part one of this three-part series, we meet Charlene, whose fear of the needle prick kept her from checking for more than a year!

Medical Reviewer: William C. Lloyd III, MD, FACS Last Review Date: Aug 13, 2015

Available Non-Insulin Injections for Diabetes

There are a number of different injectables currently available for diabetes, including:

  • GLP-1 (glucagon-like peptide-1) agonists like Byetta and Bydureon (exenatide), Victoza (liraglutide), Tanzeum (albiglutide), Trulicity (dulaglutide), and Adlyxin (lisixenatide): this medication class helps the pancreas release insulin after a meal, blocks a hormone called glucagon that increases blood sugar levels, and slows down digestion, which helps you feel fuller, faster. While there are no comparative trials of long-term outcomes with this class of drugs, one study indicates patients with a prior history of stroke or heart attack may benefit from treatment with liraglutide.

  • Pramlintide: This synthetic hormone is similar to a natural hormone called amylin that is produced by the pancreas with insulin. It blocks the release of glucagon, decreases post-meal blood sugar levels and slows the passage of food from the stomach, which promotes a feeling of fullness and reduces food intake. Pramlintide works on different molecules in your body than exenatide and is used in patients already taking insulin before each meal.

Pros

There are a number of benefits of non-insulin injectables, including:

  • With newer GLP-1 agonists, you may only need one injection per week compared to at least one per day with insulin.

  • Non-insulin injectables stimulate your body’s production of insulin when blood sugar is elevated. This decreases your risk of hypoglycemia or low blood sugar.

  • Non-insulin injectables stop your liver from increasing blood sugar when it is not needed.

  • Insulin resistance decreases with the use of non-insulin injectables.

  • Research indicates that fatty liver or NASH (non-alcoholic steatohepatitis) may be reversible with use of non-insulin injectables.

  • Non-insulin injectables slow digestion, which helps lower blood glucose levels.

  • While most diabetes treatments contribute to weight gain, you may lose some weight with non-insulin injectables. However, these medications are not prescribed solely for weight loss.

Cons

While most patients do not experience side effects with these drugs, you need to be aware of the risks as well as benefits before starting a new treatment. Consider these factors when deciding if non-insulin injectables are right for you:

  • GLP-1 drugs carry a black box warning that lab animals using the drugs have developed thyroid cancer. It is not currently known if these drugs increase cancer risk in humans. If you have a family history of thyroid cancer, you should not take a GLP-1 drug.

  • Pancreatitis, which is inflammation of the pancreas (the organ that makes insulin), is rarely reported as a side effect of GLP-1 drugs. Several experimental animal studies have raised a concern about the development of pancreatic cancer, but it’s not currently known if the drugs increase risk of pancreatic cancer in humans. If you develop pancreatitis or have a history of pancreatitis you should not take a GLP-1 drug.

  • Stomach problems such as nausea, vomiting and diarrhea are side effects of both GLP-1 agonists and pramlintide.

  • Injection site reactions such as pain, nodules, redness, swelling or infection can occur. Reactions appear more common with once-weekly versus daily injections.

  • GLP-1 drugs can damage your kidney, so they should not be used if you have previous kidney impairment.

  • Treatment with non-insulin injectables generally is more expensive than insulin therapy.

  • Pramlintide cannot be combined with insulin, which means you’ll need an additional injection with each meal.

Final Thoughts

The decision to begin any injectable is a big one for the diabetic patient. You need to discuss the pros and cons with your doctor and come up with a plan that you will be able to implement.



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.


Pat Bass III, MD

Dr. Pat Bass is chief medical information officer and an associate professor of medicine and pediatrics at LSU Health- Shreveport and University Hospital. View his Healthgrades profile >

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