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Ready for a Diabetes Drug Tune-Up?


Jun 1, 2013

Clay Wirestone

People with diabetes know the score. We've all seen "revolutionary" drugs and treatments introduced with fanfare, and we know that that much of the time they're evolutionary at best. But something has changed in the world of diabetes care.

Over the last decade or so, an array of new drugs has arrived. Drugs that promise real improvements for both type 1 and type 2 diabetes. None of them approaches a cure. But in the gradual, expensive world of diabetes care, fresh approaches aren't only welcomed, they're a necessity for those of us working to manage this condition day by day by day.

This piece will serve as a quick introduction to some of these drugs. We'll look at what they're meant to treat, how they're used and possible side effects.

Not all of the medicines covered here are appropriate for all people who have diabetes. Some are directed toward type 1s, some toward type 2s. For type 2s, who are probably more used to new pills coming online, this is a familiar position. For type 1s (like myself), it can be shocking to see entirely new frontiers of diabetic control coming into common use.

It's about time.

What They Have in Common

All of these drugs have a simple goal: They aim to lower your blood sugar. Given that most, if not all, people with diabetes share the goal of reducing their blood sugars and controlling their condition better, that's great news.

But all of these drugs also come with potentially serious side-effects. Most people with diabetes are used to the cautions that come along with a drug like insulin. Take too much, and your blood sugar will go too low. It's that simple. These newer treatments are somewhat more complex. Make sure, therefore, that you thoroughly understand what you're signing up for. 

Symlin: A Type 1 Breakthrough

The star of an article like this has to be Symlin, the injection approved by the FDA in 2005 for type 1s and type 2s. It was the first drug approved since insulin, some 80 years before, for type 1s. The drug mimics the action of amylin, a hormone that's produced by the same beta cells in the pancreas that also produce insulin.

According to official Food and Drug Administration documentation, Symlin works in three complementary ways. First, it slows down the movement of food from your stomach to small intestine, which means that sugar is absorbed more slowly and steadily by your body. Second, it reduces the amount of glucose produced by the liver. And finally, it makes people feel fuller, and therefore less likely to follow up a meal with another three or four bonus meals.

Sounds pretty good, right? Symlin has made steady inroads since it was first approved. In 2007, the FDA approved the use of pre-filled injection pens of the drug. And some doctors are even using it as an off-label drug for patients who simply need to lose weight, given the drug's effect on satiety.

On a personal note, Symlin is likely one of the next therapies I'll be investigating for my own personal use. My diabetes educators have sounded positive notes about the drug and its effects. I'm not necessarily thrilled with the prospect of adding injections back into my routine-I thought going to an insulin pump had rid me of that hassle-but the benefits look very tempting. I'll keep Diabetes Health readers up to date.

There are other challenges with the drug, too. Symlin has been known to cause nausea, and the FDA requires all boxes of the drug to carry a warning about possible severe low blood sugars. Finding the right dose will probably require work with your doctor.

What's more, if you're a type 1 with relatively tight control (which often goes along with a greater number of low blood sugars) and no weight issues, you may not be a good candidate for the drug at all. Just because you could take it doesn't mean you should.

Byetta: For Type 2s, With Risks

Byetta was approved by the FDA, also in 2005 (the agency approved it for use with insulin therapy in 2011). In several ways, it's similar to Symlin. It also reduces appetite, prevents the liver from creating as much glucose as it normally would, and slows down the digestive process.

It differs, though, in one important respect. Its key action is pushing the pancreas to produce the correct amount of insulin for the food you eat. This is especially important for type 2s, who may be struggling with increased insulin resistance.

While the drug is intended for type 2s, it has been also used by some type 1s who have a bit of pancreas function remaining. That's an off-label use, however, and should be treated with caution.

There's a fairly big caveat to Byetta, though, and that's in the side-effect column. Scientists have found an increased risk of pancreatitis in some people taking the drug. That's an inflammation of the pancreas that can lead to serious health problems. In worst-case scenarios, it can even be fatal.

That being said though, possible side effects aren't a good reason to write off a drug. Your diabetes management team should be well-educated on the subject, and they should be able to guide you as you make your decisions.

Sodium Glucose Co-Transporter 2 Inhibitors: New Kids on the Block

We come now to the most recent of this new wave of therapies. These drugs are called sodium glucose co-transporter 2 inhibitors, and they work by keeping the kidneys from reabsorbing glucose, while also pushing the body to excrete the glucose through urine.

The first drug in the class, Johnson & Johnson's Invokana, has just been approved by the FDA. It's only appropriate for use by type 2s (as a matter of fact, for type 1 diabetics, glucose excretion through the urine is to be avoided). Side effects can include vaginal yeast infections and urinary tract infections, mainly because of the higher levels of sugar contained in patients' urine.

According to the website Diabetes in Control, this is an entirely new type of drug, meant to block a protein that likely evolved many thousands of years ago.

"It is proposed that in prehistoric times, we developed an elegant system for maximizing energy conservation and storage, due to lack of consistent food supplies. This system included reducing the activity of our neurological endocrine system to slow metabolism and conserve the stored energy in our bodies, as well as a method to increase reabsorption of excess glucose that was removed by the kidneys," authors David Joffe and Marina Farid write.

Given that we now have consistent supplies of food, this reabsorption isn't necessarily needed, the authors write, and in fact can cause problems for those with type 2 diabetes. A drug restricting the protein's action therefore has a lot of promise.

Studies on the drug and other potential concerns are ongoing. What's more, Boehringer Ingelheim and Eli Lilly have their own SGC2 drug in the pipeline. So watch this space for more information as the drugs roll out.

Closing Thoughts

Just because a treatment is unfamiliar, of course, doesn't mean that it's better. And people with diabetes should be mindful of the strong supply-and-demand effect in our healthcare system. Big drug companies can read statistics as well as the rest of us, and they know that the number of people with diabetes is projected to skyrocket.

An emphasis, then, on new treatments is entirely predictable. New drugs tend to be more expensive, which means they're more profitable for drug companies and their shareholders. They also cost you and your insurance company more.

That doesn't mean the treatments won't be worthwhile, of course. Far from it. A lot of potential patients means that scientists are working on a lot of potential breakthroughs. But it's hard to know, sometimes, which drugs are the real breakthroughs and which ones are simply hyped-up versions of already available treatments. Your team of medical professionals will help you. It pays to stay informed, as well, so you're not surprised if a new treatment is suggested.

Be mindful, and proceed with caution. Your health deserves no less. But don't hesitate to investigate new therapies. The benefits could be tremendous. 


Categories: , Blood Sugar, Diabetes, Diabetes Health, Diabetes Health Magazine, Diabetic, FDA, Glucose, Insulin, Type 1 Issues, Type 2 Issues



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Comments

Posted by Anonymous on 5 June 2013

Looking at the section on Byetta, when I read the part about pancreatitis I almost had to laugh. Here is why. If the patient's pancreas is functioning propoerly but they are resistant, all this drug does is squeezes the organ, in a way. A medication that would cause the heart to pump more blood could have the side effect of some horrible heart problem, like for example stopping from over use. I feel like taking a medication for a working organ to over produce is just a bad idea.
I also have one thing to say about diabetes management teams. I have run across some that individuals within them do not understand trends or numbers that you would assume they know better than the back of their hand. So while you should be able to trust them, educate yourself before going in and look for warning signs that they do not understand what they are doing. That being said, not all care teams are like that.

Posted by Anonymous on 6 June 2013

Don't be afraid of Symlin. I actually dropped about 30 pounds. (Use the shortest pen needle.) DO watch dropping blood sugars. You will find your own pattern. I no longer use it while on the pump but it really kicked butt for dropping that weight and appetite. Good luck!

p.s. I did talk my doctor into it. He did not object but found me an unlikely candidate because he did not find me that heavy to begin with. I wanted to lose at least 15-20 pounds.


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