From the November 6, 2009 edition of the Dallas Morning News
In recent years, new drugs that can help a diabetic's pancreas work optimally have given doctors new options in controlling the disease.
One of the new class of drugs is a lab-made versions of a chemical derived from the saliva of a gila monster, also helps diabetics lose weight.
Glucose is necessary for the function of our body, it is the key fuel that the cells burn, but glucose needs insulin to enable it to enter cells where it can be used as fuel, without insulin the cells starve even though the person may be eating enough. Because the cells are hungry diabetics eat more but the hunger is not satiated since the food never reaches the cells.
Until about six years ago, drugs called sulfonylureas were prescribed to stimulate the pancreas, but their effectiveness wanes over time. The new drugs work to address the weaknesses that cause Type 2 diabetes. One class of drugs, glitazones, alters the insulin the body produces so that it will properly bind to the cells. The second, exenatide, a synthetic version of the gila monster saliva molecule, stimulates the pancreas to make more insulin. One side effect of exenatide, nausea, also triggers a sort of natural dieting, according to Cersosimo. "[Exenatide] has an effect on the appetite, and some of that is a benefit – because patients have the weight to lose," he said.
These latest drugs are most often used in combination because exenatide actually balances some side effects of glitazones, such as weight gain and fluid retention, that make glitazones problematic. But both drugs have side effects that can preclude their use. Glitazones cannot be prescribed for anyone with congestive heart failure or shortness of breath. Exenatide can induce gastrointestinal problems. Rarely, exenatide can lead to pancreatitis, which is life-threatening, Cersosimo said.
"Any medicine that you take comes with a two-page list of side effects," said Dr. Ildiko Lingvay, professor of internal medicine at UT Southwestern Medical Center.
"That's why diet and fitness are always the mainstay of therapy. And we know how effective it is, if somebody is really sticking to it." Losing a significant amount of weight can very often help.
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