Jun 14, 2011

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I love the television show Family Guy. If you have never seen it, it revolves around a foul-mouth obscene New England cartoon family. Because it is a cartoon, my kids keep trying to watch Family Guy with me. My wife then gets suitably upset and yells at me that Family Guy is inappropriate for the children. My five year old Eric loves that. He loves when I get into trouble. So Eric has started tattling on me. He has started with yelling Mom! Dad is watching something inappropriate! whenever I flip through the channels and simply pause on Family Guy too long. Lately, Eric has grown older and wiser. Whenever I start watching anything he doesnt want to see like the weather, the news, a hockey game or anything that isnt Spongebob Square Pants he tells me, Dad, this show is inappropriate! Ive been watching Erics shows often enough that I can tell you that Spongebob has a pet snail named Garry.

Eric seems to be leaving his dinosaur phase, but Im sure he would think a Gila monster would make a good pet. The Gila monster is a 2 foot long lizard that apparently is the only known venomous lizard native to the United States. Because of the venom thing, I think my wife would back me in saying a Gila monster is an inappropriate pet. The venom in the saliva is interesting though. It has been used to derive a new diabetes treatment. The new medication is called Byetta or exenatide. Byetta or exenatide is part of a group of medications called incretins.

Before we talk about how incretins work, lets do a quick refresher on diabetes. There are two main types of diabetes, Type 1 and Type 2. In Type 1 diabetes, the special cells that make insulin stop working. So Type 1 diabetics must inject insulin or they will die. Type 1 diabetics only account for about 20% of the diabetics in Canada. Almost 80% of diabetics out there have type 2 diabetes. In type 2 diabetes, the person is still producing insulin, but the muscle, fat and other cells dont listen to the signal from insulin to suck up glucose from the blood stream.

We often treat type 2 diabetes with medication. They have names like glyburide, metformin, actos and acarbose. Unfortunately, we arent winning the war on type 2 diabetes. Type 2 diabetes is becoming more common. The increase is partially blamed on the fact we are getting less active, eating more poorly and getting more obese. Diabetes can lead to serious complications. These include the big four: blindness, heart disease, kidney disease and amputation. And even in the patients we are treating now, it seems like their blood sugars keep going up despite the fact we are using multiple medications and insulin on them. It sure would be nice if we had new tools in the diabetes tool box.

Well, the new tools are called incretins. Incretins are hormones made in your gut. They are released when you eat food with carbohydrates in them. There are several naturally occurring incretins but we are going to talk about Glucagon Like Peptide 1 (GLP-1). GLP-1 does some interesting things. It delays the emptying of the stomach, it makes beta cells in the pancreas produce more insulin, reduces glucagon secretion and convinces your brain that you are less hungry.

Scientists found if GLP-1 was injected directly into patients it reduced blood sugar levels, had a low risk of making the blood sugar go too low, caused weigh loss, helped the insulin making cells stay healthy, but it caused some nausea and vomiting. That was good, but the injected GLP-1 was 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.

So the drug companies have developed two different types of GLP-1 like products. The first type of incretin is called a DDP-4. The DDP-4s block the enzyme that breaks down GLP-1. This makes the GLP-1 in the body last longer. DDP-4s are oral pills and have names like Januvia (sitagliptin), and Onglyza (saxagliptin). The second type of incretin is called a GLP-1 analog. GLP-1 analogues act like GLP-1 in the body, but they arent broken down as fast. The first GLP-1 analogue available in Canada was called Victoza or liraglutide. The new one is called Byetta or exenatide. GLP-1 analogues need to be injected.

The injection liraglutide is injected once a day. It will help a patient lose weight, and will lower their blood sugar. Liraglutide is likely to cause nausea for the first few weeks and then the nausea should go away. The new drug byetta or exenatide is injected twice a day. It will also cause weight loss and a reduction in blood sugar. Liraglutide reduces blood sugar a little bit better than the new medication exanatide. Liraglutide is only a once a day injection so it is more convenient that the new medication exenatide which is injected twice a day. Liraglutide should cause less nausea than the new medication exentide. So why would someone want try the new medication exenatide? Exenatide is cheaper.

Maybe Family Guy is inappropriate for children to watch. Maybe a Gila monster is an inappropriate for a pet for a five year old. But the medication exenatide or Byetta may be an appropriate add on medication for some type 2 diabetics.

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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.

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As always if you have any questions or concerns about these products, ask your pharmacist.


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