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Pramlintide Reduces Glycemic Swings in Type 1 Diabetes

Pramlintide, a synthetic analog of the hormone amylin, given along with insulin reduces immediate postprandial hyperglycemia in adolescents with type 1 diabetes.New FDA

In contrast, glucagon may minimize hypoglycemic episodes induced by increased insulin doses administered to prevent postprandial hyperglycemia.

“A two-pronged approach using pramlintide to prevent immediate postprandial hyperglycemia and increased insulin with minidose glucagon rescue could provide new strategies to normalize glucose excursions in children with type 1 diabetes,” Dr. Rubina A. Heptulla and her associates suggest in the April issue of Diabetes.

Dr. Heptulla stated that, “In the study, “we took well-controlled patients with type 1 diabetes who were on insulin pump therapy, because we thought they would have good control of their glycemic excursions.” The subjects included 8 type 1 diabetics and 11 controls.

However, “when we gave them their usual insulin dose and a carbohydrate meal, they had huge glycemic excursions compared with kids without diabetes.” Abnormal HbA1c levels in type 1 diabetics are therefore probably not because of their preprandial blood glucoses, but are “reflective of postprandial excursions, which are so high and so long,” she said.

“We thought that increasing that their insulin dose would prevent postprandial glucose excursions,” Dr. Heptulla continued.
However, giving subjects a 60%-higher dose of insulin prior to the meal did not prevent immediate postmeal hyperglycemia, and glucagon was needed by six of eight subjects to treat the late postprandial.

“They still get huge glycemic swings, because insulin alone can not control postprandial blood glucose,” the researcher noted.
The diabetic subjects were then given pramlintide 30 to 45 micrograms at the same time as the pre-meal bolus insulin dose. Postprandial plasma glucose concentrations were markedly reduced (p < 0.0001), reaching a nadir of 4.75 mmol/L at 70 minutes post-meal. Glucose levels increased over time after the meal, reaching a maximum of 9 mmol/L at 220 minutes.
“Pramlintide is a really good adjunct to insulin therapy that we need to control immediate postprandial glucose excursions,” Dr. Heptulla concluded.
Diabetes 2005;54:1100-1107.

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