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Type 2 Diabetes Medicines You Inject

1.

. Bydureon

What Is Bydureon?

Bydureon is a member of the GLP-1 receptor agonist* family of medicines. Bydureon works in several places in the body, and addresses four different problems that may occur in people with diabetes. It works by supporting a system of hormones in the gut called the incretin system. These gut hormones are able to detect rises in blood sugar due to food intake, and they go to work telling the pancreas to release insulin. At the same time, they tell the liver not to release stored glucose. They act sort of like a thermostat: when blood sugar goes up, they turn up the insulin, and when it goes down, they turn down the insulin. In a person with type 2 diabetes, this incretin system does not function properly, and needs some help. Bydureon has the following actions in the body:

  • Stimulates the pancreas to produce insulin when blood sugar goes up due to food intake.
  • Keeps the pancreas from telling the liver to release stored glucose after a meal when it is not needed.
  • Slows stomach-emptying time. Type 2 diabetes seems to make food clear the stomach more quickly than normal, which, in turn, causes a rapid spike in blood sugar. This rapid spike is hard for the body to handle, but a slower entry of sugar into the system is easier to handle.
  • Stimulates the satiety center in the brain. The satiety center (the I’ve had enough to eat center in the brain) tells you that you are ready to push away from your plate of food.
  • Causes weight loss. Many people will lose weight when they take these medicines, and that usually translates to better blood sugar control.

Who Can Take Bydureon?

Selected adults with type 2 diabetes can take Bydureon. You would usually have already tried diet and exercise, and another diabetes medicine, before starting Bydureon.

Who Should Not Take Bydureon?

  • People with type 1 diabetes or diabetic ketoacidosis (DKA)
  • Pregnant women
  • Individuals who are breastfeeding
  • Individuals with a history of thyroid cancer or pancreatitis
  • People with severe kidney problems
  • People with a GI disease called gastroparesis

Advantages

When used alone, Bydureon is unlikely to cause low blood sugar, and the possibility of weight loss is always a benefit for overweight people with type 2 diabetes. The once-weekly dose and the flexibility in dose timing are also positive features of Bydureon.

Disadvantages

It must be given by injection, either by the single-dose pen device or the single-dose tray. The side effects of nausea and injection-site reactions, such as raised spots at the site, can be a problem, but are not usually cause for stopping the medication.

What Dosage Can I Take, And How Should I Take It?

The dose is the same for everyone, and is 2mg weekly. It can be given anytime during the day, without regard to meals. The dosage day can be changed, or a make-up dose given if one is missed; these instructions are included with the medicine. Bydureon should be injected directly into the skin of the abdomen, back of the arm, or thigh. The injection site should be moved with every new injection to prevent the development of scar tissue. Bydureon should be injected immediately after it is mixed to get the full effect of the medicine.

What Are The Common Side Effects?

  • Nausea may occur early on, but usually begins to go away after two weeks. Techniques to prevent or lessen nausea include trying to eat much more slowly, and stopping before you feel full. Another trick is to try ginger in some form, such as real ginger ale, ginger tea, or a ginger supplement.
  • Redness or itching at the injection site
  • Raised bumps at the injection site that usually go away after a few weeks, and are not considered dangerous
  • Diarrhea
  • Vomiting
  • Headache

What Else Should I Know About Bydureon Before I Start?

There are warnings about certain types of cancer, including thyroid cancer that appeared in animals during testing of Bydureon. There are also warnings about possible pancreatitis issues. Please consult this drug’s FDA-approved medication guide for further information.

2. Byetta

(exenatide injection)

What Is Byetta?

Byetta, also known as exenatide, is the first member of the family of drugs called GLP-1 receptor agonists* to be marketed in the U.S. It is used along with diet and exercise to treat people with type 2 diabetes. It mimics the action of the natural hormone GLP-1 that is a part of the incretin system in the gut. These gut hormones are able to detect rises in blood sugar due to food intake, and they go to work telling the pancreas to release insulin. At the same time, they tell the liver not to release stored glucose. They act like a thermostat: when the blood sugar goes up, they turn up the insulin, and when it goes down, they turn down the insulin. In a person with type 2 diabetes, the incretin system does not work well, and needs some help. Byetta works in several places in the body, and addresses four different problems that people with diabetes have. Byetta has the following actions in the body:

  • Stimulates the pancreas to produce insulin when blood sugar goes up due to food intake.
  • Keeps the pancreas from telling the liver to release stored insulin after a meal when it is not needed.
  • Slows stomach-emptying time. Having type 2 diabetes seems to make food clear the stomach more quickly than normal, which, in turn, causes a rapid spike in blood sugar. This rapid spike is hard for the body to handle, but a slower entry of sugar into the system is easier to handle.
  • Stimulates the satiety center in the brain. The satiety center (the I’ve had enough to eat center in the brain) tells you that you are ready to push away from your plate of food.
  • Causes weight loss. Many people will lose weight when they take these medicines, and that usually translates to better blood sugar control.

Who Can Use Byetta?

Selected adults with type 2 diabetes can use Byetta. You will probably have already started diet and exercise along with one of the other diabetes medicines before your health care provider prescribes Byetta.

Who Should Not Use Byetta?

  • People with type 1 diabetes, or diabetic ketoacidosis (DKA)
  • Pregnant or breastfeeding women
  • Those with kidney disease, or who are on dialysis
  • People with poor digestion caused by stomach disorders such as gastroparesis

Advantages

Byetta is very effective at reducing after-meal blood sugar spikes, and also helps fasting blood sugar. Byetta may cause weight loss, and this can be a good thing for people with diabetes who are overweight. It is unlikely to cause low blood sugar when used alone, and it can be used with some of the other type 2 diabetes medicines.

Disadvantages

Byetta must be given by injection twice daily; in addition, it should be given within one hour of the morning and evening meals. It often causes nausea during the first few weeks, but that usually goes away over time. Some medicines that are taken by mouth can be interfered with when taking Byetta, so check with your pharmacist or other healthcare provider for advice.

What Dosage Can I Take, And How Should I Take It?

The initial dose is 5mcg, twice a day, and is injected into the arm, abdomen, or thigh. After one month, the dose may be increased to 10mcg twice daily. It should be given sixty minutes before the morning and evening meals. Byetta is available in a 5mcg preloaded pen and a 10mcg preloaded pen.

What Are The Most Common Side Effects?

  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Headache
  • Stomachache or indigestion
  • Jitteriness or weakness

What Else Should I Know About Byetta Before I Start?

There are warnings about possible pancreatitis issues. Please refer to this drug’s FDA-approved medication guide for further information.

Reviewed by James A. Bennett, RPh, FACA, CDE, 10/16.

3. Glucagon

Glucagon makes the list as a vital injectable because it is an emergency treatment used to reverse severe low blood sugar. Glucagon is a hormone identical to the natural human glucagon that increases blood glucose.

How Is It Used?

Glucagon is available in an auto-injector, making it easy to administer in the proper dose. It is used to correct severe low blood sugar.

What Are The Common Side Effects?

  • Nausea and vomiting may occur, but are also signs of low blood sugar.
  • Allergy symptoms, such as skin rash and breathing trouble, have been reported.

Other Information To Note

  • Friends and relatives of a person with diabetes should know the symptoms of hypoglycemia and be taught how to administer the medication, if necessary.
  • Should only be used during pregnancy if clearly needed.

Reviewed by James A. Bennett, RPh, FACA, CDE, 10/16.

4. Symlin

(Pramlintide acetate) injection

What Is Symlin?

Symlin is an injectable medication used together with mealtime insulin to control blood sugar in adults with both type 1 and type 2 diabetes. It is the only member of the family called amylin mimetics. Amylin is the natural hormone that helps to control blood sugar, but it is no longer working in people with diabetes. Symlin is a copy of the amylin hormone. It helps to lower after-meal blood sugar levels, and prevents the blood sugar spiking too high. Symlin does not replace daily insulin, but may lower the amount of insulin you need, especially before meals. It works in three ways:

  • It helps food move out of the stomach at a slower rate, which helps control the rate at which sugar enters the bloodstream following meals.
  • It reduces the amount of sugar that the liver sends into the bloodstream after meals.
  • It helps regulate food intake by decreasing appetite, potentially leading to weight loss.

Who Can Use This Medicine?

Symlin should only be used by adults with type 1 or type 2 diabetes who:

  • already use their insulin as prescribed, but still need help achieving better control;
  • will follow their doctor’s instructions;
  • are willing to follow up with their medical team regularly;
  • will test their blood sugar levels before and after every meal, and before bed; and
  • understand how Symlin works, and how to adjust doses with their medical team.

Who Should Not Use Symlin?

  • Those who cannot detect low blood sugar levels (known as hypoglycemia unawareness)
  • People who have a stomach problem called gastroparesis
  • People allergic to Symlin or any ingredients in Symlin

Advantages

This medicine is often very helpful for people who have a “rollercoaster” effect with blood glucose, particularly after eating. Since this medicine decreases appetite, you might lose some weight.

Disadvantages

Since Symlin is used with insulin to lower blood sugar, your blood sugar may drop too low, particularly if you have type 1 diabetes. When first starting Symlin, be sure to reduce your doses of insulin before meals (if recommended by your healthcare provider) to reduce the chances of low blood sugar. Since Symlin must be injected along with insulin, and the two cannot be mixed, it creates a situation in which two shots are given before each meal.

What Dosage Can I Take, And How Should I Take It?

The initial dosage for type 1 is 15mcg, and 60mcg for type 2. Both can be increased as your healthcare provider sees necessary. It is usually taken three times daily before meals.

What Are The Most Common Side Effects Of Symlin?

  • Low blood sugar
  • Nausea, vomiting, stomach pain
  • Decreased appetite
  • Reactions at the injection site

Reviewed by James A. Bennett, RPh, FACA, CDE, 10/16.

5. Tanzeum

Tanzeum (albiglutide [rDNA origin] injection)

What Is Tanzeum?

Tanzeum (albiglutide) is a member of the GLP-1 receptor agonist* family of medicines. It is given as a once-weekly injection to treat type 2 diabetes in adults, along with diet and exercise. Tanzeum works by supporting a system of hormones in the gut called the incretin system. These gut hormones are able to detect rises in blood sugar due to food intake, and they go to work telling the pancreas to release insulin. At the same time, they tell the liver not to release stored glucose. They act sort of like a thermostat: when blood sugar goes up, they turn up the insulin, and when it goes down, they turn down the insulin. In a person with type 2 diabetes, this incretin system does not function properly, and needs some help. Tanzeum has the following actions in the body:

  • Stimulates the pancreas to produce insulin when blood sugar goes up due to food intake.
  • Keeps the pancreas from telling the liver to release stored glucose after a meal when it is not needed.
  • Slows stomach-emptying time. Type 2 diabetes seems to make food clear the stomach more quickly than normal, which, in turn, causes a rapid spike in blood sugar. This rapid spike is hard for the body to handle, but slower entry of sugar into the system is easier to handle.
  • Stimulates the satiety center in the brain. The satiety center (the I’ve had enough to eat center in the brain) tells you that you are ready to push away from your plate of food.
  • Causes weight loss. Many people will lose weight when they take these medicines, and this, in turn, usually translates to better blood sugar control.

Who Can Use Tanzeum?

Selected adults with type 2 diabetes can use Tanzeum.
It can be used in combination with some of the other diabetes medicines, and basal insulin.

Who Should Not Use Tanzeum?

  • People with type 1 diabetes, or diabetic ketoacidosis (DKA)
  • Pregnant women
  • Individuals who are breastfeeding
  • Individuals with a history of thyroid cancer or pancreatitis
  • People with severe kidney problems
  • People with a GI disease called gastroparesis

Advantages

Tanzeum lowers both fasting and after-meal glucose levels. When used alone, it is not likely to cause severe low blood sugar. It is also possible that weight loss may occur over time, and this is a benefit for people with type 2 diabetes. The once-weekly dosage and preloaded pen device make it convenient to take.

Disadvantages

It must be given by injection. Tanzeum may cause nausea, especially during the first few weeks, but that usually gets better and goes away over time.

What Dosage Can I Take, And How Should I Take It?

Tanzeum is usually started at a dose of 30mg, and may be increased to 50mg once weekly. It can be given with or without food, and does not have to be given at the same time each day. It can be injected just under the skin in the abdomen, thigh, or upper arm.

What Are The Possible Side Effects?

  • Upper respiratory infection, cough, and sinus trouble
  • Nausea
  • Diarrhea
  • Constipation
  • Injection-site redness

What Else Should I Know About Tanzeum Before I Start?

The Tanzeum medication guide gives more helpful information.

Reviewed by James A. Bennett, RPh, FACA, CDE, 10/16.

6. Trulicity

Trulicity (dulaglutide)

What Is Trulicity?

Trulicity (dulaglutide) is a member of the GLP-1 agonist* family of medicines. It is given as a once weekly injection to treat type 2 diabetes in adults, along with diet and exercise. Trulicity works by supporting a system of hormones in the gut called the incretin system. These gut hormones are able to detect rises in blood sugar due to food intake, and they go to work telling the pancreas to release insulin. At the same time, they tell the liver not to release stored glucose. They act sort of like a thermostat: when blood sugar goes up, they turn up the insulin, and when it goes down, they turn down the insulin. In a person with type 2 diabetes, the incretin system does not function properly, and needs some help. Trulicity has the following actions in the body:

  • Stimulates the pancreas to produce insulin when blood sugar goes up due to food intake
  • Keeps the pancreas from telling the liver to release stored glucose after a meal when it is not needed
  • Slows stomach-emptying time. Type 2 diabetes seems to make food clear the stomach more quickly than normal, which, in turn, causes a rapid spike in blood sugar. This rapid spike is hard for the body to handle, but slower entry of sugar into the system is easier to handle.
  • Stimulates the satiety center in the brain. The satiety center (the I’ve had enough to eat center in the brain) tells you that you are ready to push away from your plate of food.
  • Causes weight loss. Many people will lose weight when they take these medicines, and that, in turn usually helps blood sugar control.

Who Can Take Trulicity?

Selected adults with type 2 diabetes can use Trulicity.

Who Should Not Take Trulicity?

  • People with type 1 diabetes or diabetic ketoacidosis (DKA)
  • Pregnant women
  • Individuals who are breastfeeding
  • Individuals with a history of thyroid cancer or pancreatitis
  • People with severe kidney problems
  • People with a digestive condition called gastroparesis

Advantages

Trulicity lowers both fasting and after meal-glucose levels. When used alone, it is not likely to cause severe low blood sugar. It is also possible that weight loss may occur over time, and this is a benefit for people with type 2 diabetes. The once-weekly dosage and preloaded pen device makes it convenient to take.

What Dosage Can I Take, And How Should I Take It?

The recommended starting dose of Trulicity is 0.75mg once weekly, and may be increased to 1.5mg, if needed. It may be taken at any time of day, with or without food. Trulicity should be injected under the skin of the abdomen, thigh, or upper arm.

What Are The Common Side Effects?

The most common side effects include:

  • Nausea, vomiting, diarrhea
  • Abdominal pain
  • Decreased appetite

What Else Should I Know About Trulicity Before I Start?

The Trulicity medication guide gives more helpful information.

Reviewed by James A. Bennett, RPh, FACA, CDE, 10/16.

7. Victoza

Victoza (liraglutide [rDNA origin] injection)

What Is Victoza?

Victoza (liraglutide) is a member of the GLP-1 agonist* family of medicines. It is the second member of its family to be marketed in the U.S., and is given as a once-daily injection to treat type 2 diabetes in adults, along with diet and exercise. Victoza works by supporting the system of hormones in the gut called the incretin system. These gut hormones are able to detect rises in blood sugar due to food intake, and they go to work telling the pancreas to release insulin. At the same time, they tell the liver NOT to release stored glucose. They act sort of like a thermostat: when blood sugar goes up, they turn up the insulin, and when it goes down, they turn down the insulin. In a person with type 2 diabetes, the incretin system does not work properly, and needs some help. Victoza has the following actions in the body:

  • Stimulates the pancreas to produce insulin when tblood sugar goes up due to food intake.
  • Keeps the pancreas from telling the liver to release stored glucose after a meal when it is not needed.
  • Slows stomach-emptying time. Type 2 diabetes seems to make food clear the stomach more quickly than normal, which, in turn, causes a rapid spike in blood sugar. This rapid spike is hard for the body to handle, but slower entry of sugar into the system is easier to handle.
  • Stimulates the satiety center in the brain. The satiety center (the I’ve had enough to eat center in the brain) tells you that are ready to push away from your plate of food.
  • Causes weight loss. Many people will lose weight when they take these medicines, and this, in turn, usually translates to better blood sugar control.

Who Can Use Victoza?

Selected adults with type 2 diabetes can use Victoza. Victoza can be used in combination with some of the other diabetes medicines, and insulin.

Who Should Not Use Victoza?

  • People with type 1 diabetes or diabetic ketoacidosis (DKA)
  • Pregnant women
  • Individuals who are breastfeeding
  • Individuals with a history of thyroid cancer or pancreatitis
  • People with severe kidney problems
  • People with a GI disease called gastroparesis

Advantages

Victoza is very effective in lowering both fasting and after-meal glucose levels. When used alone, Victoza is not likely to cause severe low blood sugar. It is also possible that weight loss may occur over time, and this is a benefit for people with type 2 diabetes. The once-daily dosage and preloaded pen device make it more convenient to take.

Disadvantages

It must be given by injection. Victoza may cause nausea, especially during the first few weeks, but that usually gets better and goes away over time.

What Dosage Can I Take, And How Should I Take It?

Victoza is usually started at a dose of .6mg, once a day for the first week of use. After that, it is usually increased to 1.2mg, and can be brought up to 1.8mg, if necessary. It is given once daily, with or without food, and does not have to be given at the same time each day. It can be injected just under the skin of the abdomen, thigh, or upper arm, and the pen device makes dialing in the proper dose a simple matter.

What Are The Possible Side Effects?

  • Headache
  • Nausea
  • Diarrhea
  • Vomiting
  • Constipation
  • Injection-site redness

What Else Should I Know About Victoza Before I Start?

There are warnings about certain types of cancer, including thyroid cancer that appeared in animals during testing of Victoza. There are also warnings about possible pancreatitis issues. Please refer to this drug’s FDA-approved medication guide for further information.

Reviewed by James A. Bennett, RPh, FACA, CDE, 10/16.

*GLP-1 Receptor Agonists

GLP-1 receptor agonists are medicines that help support hormones in the gut. These hormones play a big part in controlling blood sugar, but in people with type 2 diabetes, they sometimes don’t function as well as they should. GLP-1 (glucagon-like peptide 1) is one of these natural hormones, and it works in several ways to regulate blood sugar. If we could make incretin system hormones like GLP-1 work better, blood sugar would be easier to control; and that’s what these medicines do. The medicines act like the natural substance, but are much more powerful and produce more dramatic effects. They work to stimulate insulin release by the pancreas, slow the output of sugar from the liver, slow stomach-emptying time, and stimulate the satiety center in the brain. All of these actions together result in better blood sugar control and weight loss in most people. Since GLP-1 agonists stop lowering blood sugar once it reaches a normal level, they are unlikely to cause low blood sugar when used alone.

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