There have been a number of new developments within the management of type 2 diabetes, and a question often asked is whether a few of the type 2 therapies may be beneficial for people with type 1 diabetes. For instance, in the past, one of my patients with type 1 diabetes was having problems with Pai You Guo Tea weight with blood glucose control on the basal-bolus insulin combination. We added metformin, and his blood sugars seemed to obtain a bit better. Then we added exenatide (Byetta) before breakfast and dinner, and that he began to get much better control, lost a few pounds, and felt far better.
The first thing to consider here's that there's nothing about
having type 1 diabetes which inherently prevents one from having
options that come with type 2. When we consider it, the
prevalence of type 2 is all about 1 / 10 of all adults,
contributing to one quarter among those age 65 and older.
Features of insulin resistance - what's been called "metabolic
syndrome" - are more prevalent. So, surely a considerable number
of adults with type 1 will have options that come with type 2.
Actually, the EURODIAB study, which followed greater than 3000
people with your body, and the DCCT study of intensive control of
more than 1000 people with your body, both discovered that
features of type 2 diabetes as well as metabolic syndrome such as
weight gain, elevated triglycerides, and elevated blood pressure
all track together.
Furthermore, many of the drugs utilized in treating type 2 diabetes try to lower the blood sugar level to some degree independent of insulin - and so we may wonder if, whatever the "type" of diabetes, they might have generally beneficial effect. What exactly are some of the interesting potential approaches?
First, metformin. This is generally regarded as a fundamental treatment for type 2, there have been several studies of its use within your body returning several years. We are not whatsoever certain how it acts. In the liver as well as in skeletal muscle, metformin has actions similar to the ones from insulin, and it appears to work in the gastrointestinal tract as well to increase manufacture of a hormone called glucagon-like peptide-1 (GLP-1). GLP-1 stimulates insulin, suppresses the anti-insulin hormone glucagon, slows emptying of the stomach (for most people with diabetes, this is too rapid, so this kind of effect is advantageous in delaying the increase in blood sugar after a meal), and seems too to suppress the appetite.
Although GLP-1 itself can't be given like a treatment since it is rapidly cleared from the circulation, you will find long-acting types of GLP-1, including exenatide (Byetta and Bydureon), liraglutide (Victoza), albiglutide (Tanzeum), and dulaglutide (Trulicity). These medicines are getting studied and used in type 2 diabetic people taking insulin, as well as in many studies are as effective as insulin itself. There are a few studies suggesting they may be useful in your body too.
An even newer form of treatment methods are to give medicines which inhibit the kidneys' reabsorption of glucose. In a healthy adult, almost 200 grams of glucose go through the kidneys every day - also it all is reabsorbed. In diabetes, using the higher blood glucose levels the transporter proteins which do this are more active, to ensure that more glucose could be reabsorbed. The new medicines block point about this activity, and people with type 2 diabetes taking canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), and others in development have a tendency to slim down (the elevated urine glucose could take into account a 200 calorie per day energy deficit) and have lower blood pressure, as well as having a considerable reduction in blood glucose levels.
What happened with my patient? After four months, despite the fact that he was happy with having dropped a few pounds and with his degree of control, he began to note frequent hypoglycemic episodes, despite our reducing his insulin doses. We discontinued metformin, as that had not seemed terribly effective. And after another couple of months, we stopped Byetta. He has continued to maintain his lower weight and excellent control for the past 5 years.
None of the "type 2" medicines will replace insulin for people with type 1 diabetes - also it could be very dangerous to do this, due to the risk of severely uncontrolled blood sugar if insulin levels fall too low. And there's a counterargument, that there's no reason taking an additional medication simply to be able to make use of a bit less insulin. As many folks with type 1 diabetes are able to Te Chino Del Dr Mings Tea produce some insulin, when we could make this work more effectively it seems likely that the person's own insulin might have desirable effects in reducing glucose levels. But we must realize the opportunity of side effects to all medications. A reasonable approach is to carefully do studies of these medicines in individuals with type 1 diabetes - and also to individualize, individualize, individualize.