Exenatide for Treatment of Type 2 Diabetes

Exenatide is an injectable drug that reduces the level of sugar in the blood. It is used for treating type 2 diabetes. Exenatide belongs in a class of drugs called incretin mimetics because these drugs mimic the effects of incretins. Incretins are hormones that are produced and released into the blood by the intestine in response to food. It increases the secretion of insulin from the pancreas, slows absorption of glucose from the gut, and reduces the action of glucagon. Glucagon is a hormone that increases glucose production by the liver. All three of these actions reduce levels of glucose in the blood. In addition, it helps reduce appetite. Exenatide is a synthetic hormone that resembles and acts like incretins. In studies, exenatide-treated patients achieved lower blood glucose levels and experienced weight loss. Exenatide was approved by the FDA in May, 2005.

It is prescribed when patients with type 2 diabetes have not achieved adequate blood glucose reduction while taking metformin or a combination of metformin and a sulfonylurea. Exenatide is not used in patients with type 1 diabetes or as a substitute for insulin in patients who require insulin. There has been some side effects the most common is nausea. Other common side effects include hypoglycemia (excessively low blood glucose), vomiting, diarrhea, headache, nervousness and stomach discomfort. Patients may also experience decreased appetite, acid reflux and increased sweating. Most side effect decreases over time.

Benefits of Controlled Blood Glucose Levels

The findings from a Veterans Affairs Diabetes Trial have showed that lowering blood sugar levels to near normal through intensive treatment may reduce the risk of cardiovascular disease and heart attacks for Type 2 diabetics, but only if treatment is begun relatively soon after diagnosis and if severe episodes of low blood sugar can be avoided. Data from three studies were presented over the weekend at a San Francisco meeting of the American Diabetes Assn., and although many questions remain unanswered, some generalizations are becoming possible.

All three studies suggest that the greatest reduction in the risk of heart attacks and cardiovascular disease is achieved by lowering cholesterol levels and by controlling high blood pressure. Controlling glucose can at best provide only a small further reduction in risk that may take many years to become apparent. But that does not mean that control of blood glucose levels is not a good idea.

Data from two of the studies confirmed that such control reduces the risk of kidney and eye disease, also complications of diabetes. New data from the VA study also show that severe hypoglycemic events should be avoided at all costs. And finally, data from the three studies may ease concerns about the oral diabetes drug rosiglitazone. An analysis last year of many previous studies suggested that the drug, sold under the brand name Avandia, increases the risk of heart attacks and death. But the new studies showed no such effects from the drug, which is still in wide use

Repaglinide (Prandin) for Treating Type 2 Diabetes

Repaglinide (Prandin) is an oral medication for lowering blood sugar  in diabetics. It is in a class of drugs for treating diabetes type 2 called meglitinides and is chemically unlike other anti-diabetic medication. In a three month study, Prandin dropped fasting blood glucose values by 61 mg/dL and post meal blood glucose values by 100 mg/dL. Prandin is short acting and given before meals.  It is particularly beneficial in lowering blood glucose after meals and does not tend to lower fasting glucose levels to the same degree. Prandin has been used in combination with other medications, such as metformin (Glucophage), with impressive results. In 83 patients with type 2 diabetes, blood sugar control improved significantly with the addition of Prandin to Glucophage.

Prandin interacts with other medications. Therefore, the doctor must be aware of all other medications a patient is taking before prescribing Prandin. The usual starting dose is 0.5mg before each meal and can be increased to 4mg. The maximum daily dose is 16mg. Prandin is used with caution in people with kidney or liver abnormalities. Since Prandin increases insulin levels, it has the risk of causing abnormally low blood sugars. Blood sugars that remain severely low can result in sweating, tremors, confusion, and may lead to coma and seizure. In addition, the use of Prandin has been associated with headaches, muscle and joint aches, along with sinus infections in some individuals. This drug should not be used in pregnancy or by nursing mothers. The dose may need to be adjusted in older people, since the elderly may metabolize medications at a slower rate. 

What is Pre-diabetes?

Pre-diabetes means that the cells in your body are becoming resistant to insulin and your blood glucose levels are higher than they should be. Since the levels aren’t as high as they would be if you had Type 2 diabetes, the term “pre-diabetes” is used. Your doctor may also call this condition “impaired fasting glucose” or “impaired glucose tolerance. According to the Center of Disease Control and Prevention, 41 million adult Americans between the ages of 40 and 74 have pre-diabetes.

There are several risk factors. The risk factors are the same for pre-diabetes as they are for Type 2 diabetes. Some of them are being overweight or obese, having a sedentary lifestyle, family history, age, or having a previous diagnosis of gestational diabetes.

Often there are no signs or symptoms for pre-diabetes. Many times it is discovered during a routine physical with basic screening for fasting blood glucose levels. The normal level is below 100 mg/dl. If it’s 100 to 125 mg/dl, this indicates that you have impaired fasting glucose or pre-diabetes. Over 126 mg/dl most likely means a diagnosis of Type 2 diabetes.

If you are diagnosed with pre-diabetes, it will put you at a higher risk for Type 2 diabetes in the future. But it doesn’t have to mean that you will get Type 2 diabetes. A healthy lifestyle change can lower your risk and improve the way your body uses insulin. A low fat diet and calories can help you lose weight. The less fat and more muscle you have, the less resistant to insulin you will be. Exercising regularly not only helps you to lose weight, but also help lower your blood glucose level by using glucose as energy.

Remission of Type 2 Diabetes With Early Treatment

Type 2 diabetes affects over 250 million people worldwide. Intensive insulin therapy through daily injections is typically started late in the course of the disease. But researchers in China found that if this treatment is undertaken before the body loses the ability to control sugar levels in the blood, patients recover normal levels faster and are less at risk of remission.A team led by Jianping Weng of Sun Yat-Sen University in Guangzhou divided nearly 400 patients aged 25 to 70 with Type 2 diabetes into three groups. Two groups received intensive insulin therapy. The third group was given standard oral diabetic drugs. Treatment was stopped when regular blood glucose control had been restored for two weeks, after which patients regulated sugar levels through diet and exercise alone.

The study found that more patients in the two insulin-intensive groups hit normal levels, and did so faster, in four to six days rather than nine, compared to the control group. Also significant, remission rates were nearly twice as high in the first two groups.

A second study showed that a controlled diet and exercise over six years prevented or delayed diabetes onset by up to an additional 14 years. The two studies were published in the British journal The Lancet.

Mediterranean Diet May Protect You From Diabetes

A Mediterranean diet emphasizes olive oil, vegetables, fruits, nuts, cereals, legumes and fish, and deemphasizes meat and dairy products. A new Spanish study is suggesting that this diet may protect you against developing type 2 diabetes.

The study was published in the British Medical Journal. The researchers tracked the diets of 13,380 Spanish university graduates with no history of diabetes. Participants filled out a 136-item food questionnaire, which measured their entire diet (including their intake of fats), their cooking methods and their use of dietary supplements.

During an average of 4.4 years of follow-up, the team found that people who adhered to a Mediterranean diet had a lower risk of developing type 2 diabetes. In fact, those who stuck very closely to the diet reduced their risk by 83 percent. Moreover, the people who tended to stick closest to the diet were those with factors that put them at the highest risk for developing diabetes, such as being older, having a family history of diabetes and being an ex-smoker. These people were expected to have a higher rate of diabetes, but when they adhered to the Mediterranean diet this was not the case, the researchers noted. 

It is believed that one key factor that might be responsible for the protective effect of the Mediterranean diet is its emphasis on olive oil for cooking, frying, putting on bread and mixing in salad dressings. “There are reams of epidemiological studies that have shown an association of the Mediterranean eating pattern with better health overall,” one of the researchers said. “This study adds more fuel to the argument to make better choices in the types of fats we choose to eat and adding more vegetables to our plates.”

Tour de Cure to Benefit Diabetes Research

Tour de Cure is a fund-raising event to benefit the American Diabetes Association. It is held in 40 states nationwide. The Tour is a ride not a race. It has routes designed for everyone from the occasional rider to the experienced cyclist. No matter how far you ride there will be a route supported from start to finish with rest stops, food to fuel the journey and fans to cheer you all the way.

Every cyclist has their own reason for riding that drives them to the finish line. Maybe you have a family member or other loved one with diabetes, or maybe you have diabetes yourself. Some participants join because they love the thrill of riding with so many other cyclists on a great route. Others join because it’s a good excuse to dust off the bike and ride with the family.

Last year, more than 32,000 cyclists in 78 Tour events raised nearly $13 million to support the mission of the ADA: to prevent and cure diabetes and to improve the lives of all people affected by diabetes. Participants this year are attempting to raise money to support research for a cure for diabetes. More than 33,000 other cyclists and volunteers are expected at more than 80 sites throughout the nation this spring. To register or volunteer, call the American Diabetes Association at (888) DIABETES or go to http://www.diabetes.org/tour.

Pesticides a Link to Diabetes?

A new study in the British medical journal, The Lancet, provides more evidence that pesticide exposure may play a role in development of diabetes. The study’s authors urged researchers to focus on the role of environmental pollutants, challenging the long-held assumption that diabetes is primarily linked to “genetics and the Westernization of dietary habits and lifestyle.” An analysis of the US National Health and Examination Survey from 1999-2002 found a “strong correlation between insulin resistance and serum concentrations of persistent organic pollutants, especially for organochlorine compounds,” such as the pesticide DDT and it’s breakdown chemicals. A 2007 article in Human and Experimental Toxicology reported similar findings. In addition, a Swedish study of 380 men and women exposed to organochlorine compounds showed “a strong association with the occurrence of diabetes,” as did comparable research in Belgium. Studies of US Air Force Vietnam War vets also “suggest an adverse relation between dioxin exposure (via the defoliant Agent Orange) and symptoms of diabetes.”

Researchers at the National Institutes of Health has studied more than 31,000 licensed pesticide applicators. Licensed pesticide applicators use more potent formulations of the chemicals than are found in products sold for use in the home or garden. Among the 50 different pesticides the researchers looked at, half were chlorinated, and 7 of these were tied to an increased risk of type 2 diabetes. They are: aldrin, chlordane, heptachlor, dichlorvos, trichlorfon, alachlor, and cyanazine. The three organochlorine pesticides, aldrin, chlordane, and heptachlor, are no longer sold in the United States.

“All of the seven are chlorinated compounds,” study investigator Dr Freya Kamel of the National Institute of Environmental Health. “We don’t know yet what the implication of that is, but it can’t be a coincidence. I think it’s an important clue for future research.”

Cocoa Good For Diabetics?

A new study published in the June 3 issue of the Journal of the American College of Cardiology (JACC), suggests that cocoa can actually help blood vessels to function better and might soon be considered part of a healthy diet for the prevention of cardiovascular disease. A natural plant compound, Flavanols, is responsible for cocoa’s healthful benefits. Flavanols can also be found in tea, red wine, and certain fruits and vegetables.

The study revealed that after a diabetic patients drank specially formulated high-flavanol cocoa for one month, blood vessel function went from severely impaired to normal.  Cardiovascular disease is the number one cause of death in diabetic patients.

“Medical treatments alone often do not prevent complications of diabetes that are associated with atherosclerosis and cardiovascular disease,” said Malte Kelm, M.D., a professor and chairman of cardiology, pulmonology and vascular medicine at the University Hospital Aachen and the Technical University Aachen, in Aachen, Germany. “Physicians should be increasingly looking to lifestyle changes and new approaches to help in addressing the cardiovascular risks associated with diabetes.”

“Patients with type 2 diabetes can certainly find ways to fit chocolate into a healthy lifestyle, but this study is not about chocolate, and it’s not about urging those with diabetes to eat more chocolate. This research focuses on what’s at the true heart of the discussion on “healthy chocolate”—it’s about cocoa flavanols, the naturally occurring compounds in cocoa,” he said. “While more research is needed, our results demonstrate that dietary flavanols might have an important impact as part of a healthy diet in the prevention of cardiovascular complications in diabetic patients.”

Hot Tub for Diabetics?

Can enjoying a dip in a hot tub be good for diabetics? According to a pilot study that appeared in the September 16 issue of The New England Journal of Medicine, “hot tub therapy” helped a group of type 2 diabetics reduce their blood sugars, lose weight and improve sleep patterns.

Another study was done by Philip L. Hooper, MD, of the McKee Medical Center in Loveland, Colorado. He studied five type 2 men and three type 2 women. The patients had been suffering from diabetes from three to 14 years. The subjects sat in the hot tub by themselves with water up to their shoulders for 30 minutes per day, six days per week, for three weeks. Most patients had reduced blood glucose levels and had even lost some weight. Although, “Most subjects found that their blood sugars went back up two to three weeks after stopping the study,” says Hooper.  

“These results suggest that hot tub therapy should be further evaluated as a therapy for patients with type 2 diabetes mellitus,” says Hooper. “It may be especially helpful for patients who are unable to exercise.”

Hooper is in the process of writing a grant for further research in this area from the National Institutes of Health, the American Diabetes Association and possibly the American Heart Association. “My study was a pilot study, which was published in order to provide a new thought in the management of diabetes,” says Hooper. “It cannot be endorsed as an ‘approved’ method of therapy at this time.”

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