The GLP-1 Agonists

Victoza (liraglutide [rDNA origin] injection)

I dislike starting this with a warning, but it is important and valid for this medication. Just because a celebrity chef (Paula Deen) promotes this medication does not make it safe and I suspect there will be more warnings in the future.

Warning Liraglutide injection may increase the risk that you will develop tumors of the thyroid gland, including medullary thyroid carcinoma (MTC; a type of thyroid cancer), which may cause death if it is not treated at an early stage. If you develop thyroid cancer, your thyroid gland may need to be surgically removed. Tell your doctor if you or anyone in your family has or has ever had thyroid cancer, medullary thyroid carcinoma, or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2; condition that causes tumors in more than one gland in the body). If so, your doctor will probably tell you not to use Liraglutide injection. If you experience any of the following symptoms, call your doctor immediately: lump or swelling in the neck; hoarseness; difficulty swallowing; or shortness of breath.

Keep all appointments with your doctor and the laboratory. Your doctor may order certain tests to check your body's response to Liraglutide injection.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with Liraglutide injection and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.

Talk to your doctor about the risks of using Liraglutide injection.

I strongly urge you to read this link (a PDF file) or the suggested links above in the warning so that you can familiarize yourself about Victoza. There are many special instructions that need to followed for proper use and avoiding problems with Victoza. Victoza is manufactured by Novo Nordisk.

Amylin Mimetic (Symlin) (pramlintide acetate)

This medication is not for people with type 2 diabetes taking oral medications. It is only for people already taking insulin. There are several warnings you must take seriously. Symlin cannot be used in place of insulin. You must use a separate syringe to inject Symlin. Symlin may reduce the amount of insulin you need to use. Non-compliance is a problem for those taking Symlin.

Symlin does help keep your blood glucose at lower levels after you eat by helping your liver not put glucose into your blood stream. It may also prevent hunger, causing you to eat less and has the potential to assist in losing weight.

You should not take Symlin and need to talk with your doctor if you can't tell when you are having low blood glucose, a condition called hypoglycemia unawareness, you have recently had severe low blood glucose, you have stomach problems caused by diabetes-related nerve damage, and the standard if you are pregnant, planning to get pregnant, or breastfeeding. Symlin has not been studied for use in children. There may be times when you should not take your usual dose of Symlin and this includes if you're having surgery and you’re sick and can’t eat. Also, discuss with your doctor about other times not to take Symlin.

Symlin can cause the following side effects and you should be prepared for them. They include - nausea and vomiting-most often when you first start taking Symlin, swelling, redness, or itching of the skin where Symlin is injected, headache, decreased appetite, stomach pain and indigestion, tiredness, and dizziness. Symlin does not cause low blood glucose by itself; however, your risk of having low blood glucose is higher because Symlin is always taken along with insulin.

Symlin is manufactured by Amylin Pharmaceuticals, Inc.

Incretin Mimetic Byetta and Bydureon (extended-release for injectable suspension) (exenatide)

Byetta and Bydureon are very much like Symlin, but you need to add that both help slow digestion by moving the food slowly through your stomach. Both are not to be used in place of insulin; however, people on oral medications or not on any medications may use it if appropriate.

You should not take Byetta or Bydureon and need to talk with your doctor if you have severe stomach or digestive problems, you have any symptoms of kidney disease or are on dialysis, you are pregnant, planning to get pregnant, or breastfeeding, and you have type 1 diabetes. Both have not been studied for use in children.

The possible side effects Byetta and Bydureon can cause are - nausea and vomiting-most often when you first start taking them, headache, diarrhea, and dizziness. Byetta and Bydureon also can cause an acid stomach or make you feel nervous.

If you are planning to take either, you need to know about problems with your kidneys

and talk with your doctor right away if you notice any of the following - changes in the color of your urine, how often you urinate, or the amount you urinate. swelling of your hands or feet, tiredness, changes in your appetite or digestion, and a dull ache in your mid to lower back. Byetta and Bydureon do not cause low blood glucose by itself, but your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose, or insulin. Your doctor may advise you to take a lower dose of your other diabetes medicines while you are taking Byetta or Bydureon.

Byetta and Bydureon are manufactured by Amylin Pharmaceuticals, LLC and AstraZeneca Pharmaceuticals LP.

These GLP-1 agonists are all under suspicion of causing pancreatitis and pancreatic cancer, but presently the FDA is not convinced and seems to be waiting for additional adverse events.

Back to Diabetes Basics – Part 12

If I had not for looking for something else, I may have passed over these medications.

Amylin Mimetic (Symlin)

This medication is not for people with type 2 diabetes taking oral medications. It is only for people already taking insulin. There are several warnings you must take seriously. Symlin cannot be used in place of insulin. You must use a separate syringe to inject Symlin. Symlin may reduce the amount of insulin you need to use. Non-compliance is a problem for those taking Symlin.

Symlin does help keep your blood glucose at lower levels after you eat by helping your liver not put glucose into your blood stream. It may also prevent hunger, causing you to eat less and has the potential to assist in losing weight.

You should not take Symlin and need to talk with your doctor if you can't tell when you are having low blood glucose, a condition called hypoglycemia unawareness, you have recently had severe low blood glucose, you have stomach problems caused by diabetes-related nerve damage, and the standard if you are pregnant, planning to get pregnant, or breastfeeding. Symlin has not been studied for use in children. There may be times when you should not take your usual dose of Symlin and this includes: if you're having surgery and you’re sick and can’t eat. Also, discuss with your doctor about other times not to take Symlin.

Symlin can cause the following side effects and you should be prepared for them. They include - nausea and vomiting-most often when you first start taking Symlin, swelling, redness, or itching of the skin where Symlin is injected, headache, decreased appetite, stomach pain and indigestion, tiredness, and dizziness. Symlin does not cause low blood glucose by itself; however, your risk of having low blood glucose is higher because Symlin is always taken along with insulin.

Incretin Mimetic (Byetta)

Byetta is very much like Symlin, but you need to add that Byetta helps slow digestion by moving the food slowly through your stomach. Byetta is not used in place of insulin; however, people on oral medications or not on any medications may use it if appropriate.

You should not take Byetta and need to talk with your doctor if you have severe stomach or digestive problems, you have any symptoms of kidney disease or are on dialysis, you are pregnant, planning to get pregnant, or breastfeeding, and you have type 1 diabetes. Byetta has not been studied for use in children.

The possible side effects Byetta can cause are - nausea and vomiting-most often when you first start taking Byetta, headache, diarrhea, and dizziness. Byetta also can cause an acid stomach or make you feel nervous.

If you are planning to take Byetta, you need to know about problems with your kidneys

and talk with your doctor right away if you notice any of the following - changes in the color of your urine, how often you urinate, or the amount you urinate. swelling of your hands or feet, tiredness, changes in your appetite or digestion, and a dull ache in your mid to lower back. Byetta does not cause low blood glucose by itself, but your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose, or insulin. Your doctor may advise you to take a lower dose of your other diabetes medicines while you are taking Byetta.

Liraglutide Injection (Victoza)

I dislike starting this with a warning, but it is necessary and valid for this medication. Just because a celebrity chef (Paula Deen) promotes this medication does not make it safe and I suspect there will be more warnings in the future.

Warning Liraglutide injection may increase the risk that you will develop tumors of the thyroid gland, including medullary thyroid carcinoma (MTC; a type of thyroid cancer), which may cause death if it is not treated at an early stage. If you develop thyroid cancer, your thyroid gland may need to be surgically removed. Tell your doctor if you or anyone in your family has or has ever had thyroid cancer, medullary thyroid carcinoma, or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2; condition that causes tumors in more than one gland in the body). If so, your doctor will probably tell you not to use Liraglutide injection. If you experience any of the following symptoms, call your doctor immediately: lump or swelling in the neck; hoarseness; difficulty swallowing; or shortness of breath.

Keep all appointments with your doctor and the laboratory. Your doctor may order certain tests to check your body's response to Liraglutide injection.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with Liraglutide injection and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.

Talk to your doctor about the risks of using Liraglutide injection.

I strongly urge you to read this link or the suggested links above in the warning so that you can familiarize yourself about Victoza. There are many special instructions that need to followed for proper use and avoiding problems with Victoza.

Series 12 of 12

Avoiding Weight Gain If You Take Insulin

The myth about weight gain on insulin happens to be fact, although in reality it is muddied up by people. For people with type 2 diabetes, taking insulin can cause weight gain. There are several reasons for this. The one factor that comes to the front is people use insulin as the medication of last resort. Normally this is fought until there is no longer any choice, insulin cannot be postponed as blood glucose levels are out of control and oral medications cannot keep blood glucose levels down.

Because insulin is often the medication of last resort, two factors can cause weight gain. The first is inactivity or sedentary lifestyle. This may be caused by diabetic neuropathy, which makes it difficult to walk more than short distances. The second is people do not reduce the intake of carbohydrates when going on insulin.

Why is the second necessary? Because insulin is necessary, when first started, insulin makes management of blood glucose levels easier. Instead of losing some of your carbohydrates in your urine when your blood glucose exceeded your urinary limits, these carbohydrates are now put to work or stored as fat. This new efficiency in blood glucose management generally causes initial weight gain.

This is the main reason that people starting on insulin should consider reducing the total carbohydrate intake for a period of time while your body adjusts to the efficiency. However, if you are a person that is able to exercise on a regular basis and you do this, your carbohydrate intake may not be reduced greatly and may be resumed shortly after starting insulin.

Weight gain is always a possibility for some body types and people must learn to manage their carbohydrate intake to avoid weight gain. The article did say that you should limit your insulin dosage, which is only possible, if you reduce your intake of carbohydrates. I will also reemphasize their statement of using exercise to aid in insulin use to burn calories and help keep insulin use low. This will aid in preventing weight gain.

In conclusion, I will state that insulin should not be considered by people with type 2 diabetes as the medication of last resort. Learn about it before the need arises and before you have the neuropathy, which can make exercise more difficult. One tip you should also consider is possibly using Byetta, which will assist you in reducing your carbohydrate intake, and help you keep extra weight off and to assist you in losing some of the extra weight you have accumulated over the years. Talk to your doctor, as this needs to be understood before using it. Consider getting an appointment with an endocrinologist for using insulin to aid you in your management of type 2 diabetes.

Byetta Has Powerful Anti-inflammatory Effect

Byetta is a diabetes medication that I have wrestled with for several years about using. My endocrinologist and several friends have encouraged me to use it, but I have resisted because of the unpleasant side effects. Then along comes a press release that has me thinking about it again.

Exenatide (Byetta) is a drug prescribed to diabetes patients to improve blood glucose management. Now according to a University of Buffalo study, it has a powerful and rapid anti-inflammatory effect.

“"Our most important finding was this rapid, anti-inflammatory effect, which may lead to the inhibition of atherosclerosis, the major cause of heart attacks, strokes and gangrene in diabetics," says Paresh Dandona, MD, UB Distinguished Professor in the Department of Medicine, UB School of Medicine and Biomedical Sciences, and senior author.” This is a gigantic plus and will factor into my decision.

It is interesting that the study reports that this anti-inflammatory effect happens completely independent of weight loss over the 12-week study period. This is important as obesity is an inflammatory problem and adipose tissue contributes to inflammation. Weight loss on its own can lead to an anti-inflammatory effect.

The authors of the study state that corticosteroids and insulin which are anti-inflammatory, but neither drug demonstrates such a powerful and rapid anti-inflammatory effect. Plans are under way to use exenatide in acute inflammatory cases in intensive care units or following heart attacks and strokes, where rapid anti-inflammatory effect is required and such drugs may be of potential use and helpful.