Introducing Soliqua - a new diabetes medication on the market

Nov 30, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"14". Your Honour, members of the Jury, that is not an appropriate phone greeting. The blame for this verbal tick falls squarely on Hallmark Christmas movies. You'll note I did not say, "Clinic Pharmacy, Trevor speaking" like I do a hundred times a day. No, I picked up the handset and said "14". Unwittingly substitution of one telephone greeting for another in not uncommon. During a recent call, someone I've known for years answered, "Good afternoon, Parkview Dodge". That was despite the fact the call was in the morning, the dealership in question hasn't been called "Parkview Dodge" for years, and he hasn't worked there for even longer. But at least it was a standard phone greeting, if somewhat out of context. I picked up the phone, my brain thought, "Clinic Pharmacy, Trevor speaking" but my mouth actually said, "14". I was baffled, the customer was befuddled, and my co-workers were extremely amused. I will show the over-festivization of the Christmas Season due to Hallmark Movies is the cause of this hopefully temporary delirium and brain damage that led to my brain-mouth disconnect.

I was not delusional when I listened a short education session about a new diabetes treatment called Soliqua. It contains a long acting insulin and an incretin. It piqued my interest when I was told it shouldn't be used in Type 1 diabetes. That sounded unusual because we use lots of different insulin products in Type 1 diabetes.

First a thumb nail sketch. There are two main types of diabetes, Type 1 and Type 2. In Type 1 diabetes, the special cells that make insulin in the pancreas stop working. Type 1 diabetics must inject insulin, or die. Type 1 diabetics only account for about 20% of the diabetics in Canada. Almost 80% have Type 2 diabetes. In Type 2 diabetes, the person is still producing insulin, but the muscle, fat and other cells aren't listening to the signal from insulin to suck up glucose from the blood stream. We call that insulin resistance. There are lots of pills we use in Type 2 diabetes. Sometimes we also use insulin, with or without pills.

Type 2 diabetes is becoming more common. We think the increase is due to lifestyle. We are getting less active, eating more poorly and getting more obese. Type 2 diabetes leads to the big four: blindness, heart disease, kidney disease and amputation. Those terrible outcomes have led researchers to look for additions to the Type 2 diabetes toolbox.

One of the new tools that have been discovered are called incretins. One of the body's incretins is called Glucagon Like Protein-1 (GLP-1). Scientists found that if GLP-1 was injected into patients, it reduced blood sugar levels, had a low risk of making the blood sugar go too low, caused weight loss, helped the insulin making cells in the pancreas stay healthy, but caused some nausea and vomiting. The downside is the injected GLP-1 is broken down by the body within minutes. To get any good effects they had to continuously pump it into the test subjects. That would not be practical for the average type 2 diabetic.

In 2002 researchers found an extract from the Gila monster lizard saliva stimulated the GLP-1 receptor and wasn't broken down in minutes. This GLP-1 receptor agonist caused the pancreas to secrete insulin when glucose was around. And in 2005, exenatide became an injectable drug for Type 2 diabetes. Since then, several GLP-1 agonists have been developed.

That brings us back to Soliqua. It has the long acting insulin called insulin glargine and the GLP-1 agonist called lixisenatide in it. Combining a long acting insulin with a GLP-1 agonist should make the patient need less overall insulin to achieve the same blood sugar reduction. This should also cause less weight gain. It should only be used in Type 2 diabetics, because only they seem to respond to GLP-1 agonist treatments.

One of the downsides of these combo products is price. Soliqua will cost over $200 per month and anther combo called Xultophy will cost over $300 per month. These combo products won't work for Type 2 diabetics that need large amounts of insulin. For example, Soliqua's maximum dose is 60 units. Xultophy has the GLP-1 agonist called liraglutide in it which seems to be good for diabetics with heart disease. The short acting lixisenatide in Soliqua doesn't seem to have any heart benefits. Even if there is medicine left in it, you are instructed to throw out your Xultophy pen 21 days after starting it and Soliqua pen 28 days after starting it.

Most government drug plans don't willingly pay for newer, expensive medications. On a surprising upside, Non-Insured Health Benefits or Indian Affairs will consider paying for Soliqua if extra paperwork is completed. And that is not a slip of the tongue.

Over-festivization has caused my brain-mouth disconnect, Your Honour and Hallmark is the cause. Hallmark Christmas movies are too numerous and they start too early. They are the final straw of over-festivization that cripple my psyche this time of year. Even before the Hallmark Movie Mayhem starts, I am prone to Christmas over-festivization faux-pas's. A text laden Christmas ornament on a co-worker's Facebook page inspired my well-intentioned critique that, "No one wants to read a Christmas tree". I was told the ornament said, "Because Someone we love is in Heaven, there's a little bit of Heaven in our Home" and it was to honor her recently deceased grandmother. My well intentioned decorating advice now made me look like a heartless monster. That is just the beginning of over-festivization season and how it rots the brain. The Christmas scenes on McDonald's coffee cups are completely superfluous. I say "Bah Humbug" to them and am called a Grinch. People tell me Christmas Spirit saved the Grinch. However, if the Grinch's heart really did grow to three times its normal size, that would be left ventricular hypertrophy and that is not a good thing. Throw in a marathon of Hallmark Christmas movies into this miasma of over-festivization and brain damage and delirium are almost certain. Over-festivization thought malfunction has been in the medical literature since 1843 when Charles Dickens published a case study titled, "A Christmas Carol". A successful businessman was driven to seeing delusionary figures by over-festivization. These delusions commanded him to perform actions against his will. The poor fellow gave away all his money, lost the respect of the business community and died penniless. Scrooge is patient-zero of Christmas over-festivization. And that, your Honour, is how Christmas over-festivization in general, and Hallmark Christmas movies in particular, have ruined my brain. "14"

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Canadian Diabetes Association - www.diabetes.ca

 


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