Who is the Best Candidate for Non-Insulin Injectables?
The number of diabetes cases is growing, but so are therapeutic options for treating this life-long illness. Physicians can now present patients with a much broader range of treatment choices that can be tailored to their needs. Over the last 10 years, non-insulin injectable drugs have been shown to be effective therapeutic options in the continuum of diabetes care. As a physician, I’ve seen many of my diabetes patients improve significantly using this class of drugs.
What Is a “Non-Insulin Injectable?”
‘Non-insulin injectable’ is a generic term that encompasses any medication injected to treat diabetes aside from insulin. The term typically refers to a group of six drugs; five belong in the glucagon-like peptide 1 (GLP-1) receptor agonist class, and another is considered an “amylin analog.” These seven medications have been approved by the U.S. Food and Drug Administration (FDA) to treat diabetes. The GLP-1 drugs mimic the body’s native hormone that tells the brain to prepare for the arrival of food and to stop eating when full. The GLP-1 class also helps stimulate insulin production, needed to regulate your blood sugar level, decrease production of glucagon, the hormone which asks the liver to produce more of your own sugar, and store energy from the food you eat. Currently, the FDA has approved the following GLP-1 drugs for diabetes: exenatide (Byetta), exenatide extended release (Bydureon), albiglutide (Tanzeum), dulaglutide (Trulicity), and liraglutide (Victoza).
The amylin analog, or pramlintide, is an injectable drug (Symlin), that works similarly. Diabetes impairs the production of the hormone amylin, which assists insulin in controlling post-meal glucose, or blood sugar, levels. The amylin analog works by telling your brain to curb your appetite and slow the exit of food from your stomach.
While the amylin analog is approved to treat type 1 and type 2 diabetes, the GLP-1 drugs were developed only for patients with type 2 diabetes, a disease in which your body doesn’t use insulin properly, leading to what’s called ‘insulin resistance.’ Unless a patient has certain conditions that might prevent him or her from using the drugs, I consider almost any patient with type 2 diabetes a potential candidate for the GLP-1 class if lifestyle changes alone don’t control his or her blood sugar levels. The drugs in this class can be taken in combination with other medications, at any stage in your diabetes, and they work through multiple mechanisms in the body to achieve results. The amylin analog, on the other hand, is only approved to be taken together with insulin injections prior to all meals.
How They Work
Weight gain is one of the major contributing factors to type 2 diabetes, and the GLP-1 injectables directly target this issue, causing a sense of fullness and other factors that can lead to weight loss. They also help to slightly lower blood pressure, particularly if a patient has high blood pressure, which is a common issue with diabetes patients. For this reason, I recommend these agents be used in the beginning of a patient’s diabetes treatment course, especially for patients that struggle to lose weight and keep their blood pressure down. The amylin analog also targets factors that lead to weight loss by fine tuning a patient’s response to food intake and by lowering glucose levels. But again, unlike the GLP1-class this drug can only be used with insulin in a treatment plan.
Depending on which drug and dosage your physician prescribes, you might inject the medicine once a day or once a week. Taking injections may sound off-putting, but because these drugs are so effective, I rarely have patients stop taking these injections. That’s why initial education on the part of the physician is important. These injections are relatively easy to do, almost painless, and can be injected in less-sensitive parts of the body like the abdomen, the back of the arm, and the thigh. It is important to note that amylin cannot be taken in the same syringe as insulin.
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.
George Grunberger, MD, is chairman of the Grunberger Diabetes Institute in Bloomfield Hills, Michigan. He is also a clinical professor of internal medicine as well as molecular medicine and genetics at Wayne State University School of Medicine in Detroit. View his Healthgrades profile >
Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced
or reprinted without permission from Healthgrades Operating Company, Inc. Use
of this information is governed by the Healthgrades User Agreement.