Tuesday , November 21 2017
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Production Assistant, Diabetes In Control

GLP-1 and Basal Insulin

Test Your Knowledge

Which of the following GLP-1 agonists is not currently approved for use with basal insulin? A. Exenatide (Byetta) B. Dulaglutide (Trulicity) C. Albiglutide (Tanzeum) D. Liraglutide (Victoza) E. None of the above Did you get it right? Follow the link to find out!

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What is the Most Ineffective Medication?

As we know, the most ineffective medication is the one needed but never taken. There are many reasons our patients don’t take prescription medicines, but a biggy is the cost. If a medicine is too expensive, the patient will not fill the prescription, therefore won’t take it. For example, when ordering an SGLT-2 and/or GLP-1, each can cost hundreds or more for a month’s prescription. Some are covered for both. Some are covered for one brand, but not the other.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #79: Insulin Actions In Vivo: Glucose Metabolism Part 5 of 9

The fed state is the absorptive period between meals. Carbohydrates are normally mixed with lipids and protein in the diet and make up 40 – 60% of the caloric content. Absorption of dietary carbohydrates is influenced by their chemical form (refined sugars or complex carbohydrates) and by other components of food. Furthermore, disposition of dietary carbohydrate is indirectly affected by fats and protein to the extent that these latter (i) compete with glucose as substrates, and (ii) interfere with glucoregulatory hormones by altering insulin secretion.

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Just Because It Says “—” Doesn’t Mean It Is

Male, 62 years of age, type 2 diabetes, class III obesity. Has been on metformin, 1,000mg twice daily. Glucose in the 200-300mg/dL range. A1C. Taught about lower carb meal plan, started on Trulicity, first 0.75mg, then 1.5mg/dL. Made the dietary changes right away with the addition of the Trulicity. Within 2 weeks glucose levels averaged 125, patient losing weight, decreased appetite and feeling good. More energy. Insurance did not cover Trulicity, but did cover Victoza, so started on Victoza. When made the change, started with the 0.6mg daily, then increased weekly to the 1.8mg/day.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #78: Insulin Actions In Vivo: Glucose Metabolism Part 4 of 9

Glucose disposal: In the basal state, steady/near steady-state conditions prevail and whole-body glucose disposal equals endogenous (hepatic) plus renal glucose production. Data on the individual contribution of organs and tissues to total glucose uptake have been obtained in regional catheterization studies. In the case of the splanchnic area, in which glucose uptake and production both occur simultaneously, such data have been derived from the combined use of glucose tracers and indwelling catheters.

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