The Medicine Mix

Your doctor is best guide when bewildered about diabetes medication.

Theresa Garnero By Theresa Garnero, APRN, BC-ADM, MSN, CDE

This month's column answers reader's questions about diabetes medications. Did you know that only 50% of people take medications as directed by their physician? Please check with your healthcare provider before making any changes.

1. SYMLIN: INSULIN'S COUNTERPART

Q. I'm beginning to hear about something called "Symlin." What is it and how does it work? What are the side effects? Could it be used along with Lantus? I am a type 2 and have a range of high sugars in the morning from 150-160—am I a good candidate for Symlin?

A. Symlin is a new, injectable medication that controls after-meal glucose values. Symlin (pramlintide acetate) is a synthetic (made in the lab) form of amylin, a hormone that is located in and secreted with insulin from the pancreatic beta cells. Discovered in 1987, amylin is deficient in people with diabetes.

How does it work? Symlin controls post-meal glucose levels by suppressing glucagon secretion (excessive glucose release from the liver). Symlin also decreases gastric emptying which results in a slower release of glucose into the bloodstream, reduces glucose fluctuations, decreases appetite, and causes a little weight loss. Symlin regulates glucose appearance (from the liver) whereas insulin regulates glucose disappearance (into the cells); they work hand in hand.

Who are good candidates for Symlin? It is used for people with type 1 and type 2 diabetes who are on insulin and haven't met target glucose values, especially in post-meal ranges. Symlin can be used with Lantus, or any other insulin, and Metformin or sulfonylureas (Glyburide, Glipizide). Symlin may not be mixed or added to the syringe containing insulin, so you would need to take a separate shot.

In terms of your high fasting glucose values, I would suggest talking with your healthcare provider. The Lantus dose impacts fasting values more so than Symlin would. However, based on your A1C and post-meal values, Symlin may be useful for you.

Symlin would not be appropriate for those with poor adherence to current insulin regime or self-blood glucose monitoring, for A1C values (3-month average glucose) of more than 9%, or people who have had gastric bypass surgery or take other drugs that slow down gastric emptying. Symlin has not been evaluated in children or pregnant women.

What are the side effects? The most commonly reported side effects occur during initiation of Symlin therapy: nausea, headache, vomiting, and abdominal pain, along with minor reactions at the injection site. The risk for hypoglycemia is increased for people taking insulin or a sulfonylurea which is why it is important to be under the care of a healthcare provider and diabetes educator.

How effective is Symlin? After 6 months of therapy, studies show type 1s had an average A1C decrease of 0.43 percent and a weight loss of 3 pounds. For type 2s, the average A1C decrease was 0.57 percent with a weight loss of 6 pounds.

2. METFORMIN-ACTOS BEAT GOES ON

Q. I have taken Metformin for 2 years and had Actos recently added to my regimen. I quickly became irritable and my blood pressure and pulse stay very high. Would this be attributable to the new medication and how many days would be appropriate to wait before notifying the doctor?

A. With any sudden changes, especially those involving the heart, I would recommend contacting your physician immediately. Some people experience edema as a side effect of Actos which could then put a strain on a fragile heart. And although all medications have a variety of idiosyncratic (unexpected and rare) side effects, irritability and increased blood pressure/pulse is not a common problem associated with Actos. Your physician can help sort out why your heart rate and blood pressure changed so suddenly.

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Last Modified Date: February 28, 2013

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by Brenda Bell
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...
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