Medicine #1
Byetta works by:
- Helping the pancreas release more insulin.
- Slowing down how quickly food is absorbed.
- Helping you feel full faster.
- Decreasing the production of glucose by the liver.
Did You Know? Scientists were able to use their knowledge about the pancreas of a large, unique lizard to make Byetta in the laboratory.
Medicine #2
Symlin works by:
- Slowing down the rate that food moves from your stomach into your intestines, without changing the amount of nutrients your body gets.
- Helping to decrease your appetite.
- Decreasing the production of glucose by your liver.
Pramlintide is the active ingredient in Symlin and is approved for people with type 1 and type 2 diabetes who use insulin. Symlin affects after-meal blood glucose levels as described above.
Last spring, two new diabetes medicines were approved by the Food and Drug Administration and are now available. These new medicines may offer you another option for managing your diabetes. In some ways, these two medicines are similar. They both act like hormones the body normally makes. They both help to lower blood glucose after meals. Yet in other ways they are very different: one medicine helps your pancreas release more insulin and the other helps regulate how quickly glucose goes into the blood stream.
BYETTA
The first medicine is called Byetta (exenatide) and is for people with type 2 diabetes. The way that it was discovered is a bit unusual. Scientists knew that a large, unique type of lizard called the gila monster eats only four times per year. In between, they are able to turn off their pancreas so that no insulin is released. When it is time to eat, the gila monster makes exendin-4 (exenatide). Exendin-4 helps to turn its pancreas back on so it can make insulin. This hormone is similar to the hormone, GLP-1, that is made in the gut. However, people with type 2 diabetes make less of this hormone than those without diabetes.
Byetta must be taken by injection, and in this way it is similar to insulin—but Byetta is not insulin. Byetta helps your body release more insulin and only works when your blood glucose goes up. You do not need to change your dose to adjust for the size of your meal or for physical activity.
Byetta is taken along with metformin (Glucophage) and/or sulfonylureas, such as glimepiride (Amaryl), glipizide (Glucotrol) or glyburide (Micronase). It is taken twice a day, within an hour before breakfast and supper. The injection is given with a pre-filled pen device. The pen needs to be kept in the refrigerator, but it can be out for short periods of time.
SYMLIN
The second new medicine is called Symlin (pramlintide). Symlin can be used by people with type 1 diabetes or type 2 diabetes who take insulin. Pramlintide is the lab-made version of a hormone called amylin. Amylin is normally made in the pancreas by the beta cells—the same cells that make insulin. When you eat, the pancreas releases amylin along with insulin to keep your blood glucose levels from going too high. People with diabetes who need insulin to regulate their blood glucose levels also lack amylin. Symlin is taken before meals, along with insulin. You do not take it if the meal has less than 30 grams of carbohydrates, which is the amount of carbohydrates in 2 slices of bread or a small baked potato. If you are ill and cannot eat or need to fast for any reason, do not take your dose.
You take Symlin with an insulin syringe, but it cannot be given in the same syringe as insulin. You can give it in the stomach or thigh, just as long as it is two inches from your insulin injection. Symlin is stored in the refrigerator until it is opened. Once it has been opened, it is kept at room temperature and is good for 28 days. Symlin is recommended for people who take insulin before each meal, but whose blood glucose levels are not in their target range after meals. Symlin is not for people who cannot tell when their blood glucose is too low, who have gastroparesis or who are pregnant, nursing or planning to become pregnant.
SIDE EFFECTS
- Like all medicines, Byetta and Symlin can have side effects.
- Some people feel nauseous at first, but this can usually be managed by taking a low dose, and then increasing the dose.
- While neither medicine alone causes hypoglycemia, a low blood glucose reaction can occur when Byetta is taken with a sulfonylurea or when Symlin is taken with insulin.
- Adjusting your dose of sulfonylurea or insulin can help reduce the risk for hypoglycemia.
IS ONE OF THESE NEW MEDICINES FOR ME?
If your A1C level or your after-meal blood glucose levels are higher than you want, Byetta or Symlin may be right for you. Talk with all of your health care providers. Be sure to tell them all of the medicines you take, including vitamins and herbs. There is another important thing to consider. Since these medicines are new, your health insurance or prescription plan may not cover the cost. It’s a good idea to call your insurer to be sure it is covered before you ask for a prescription. Also keep in mind, the medicine may need to be special ordered by the pharmacy.
New types of medicines give people with diabetes more choices and that is good news. So the next time you see a gila monster, say thank you before you run away.
