Type 2 Diabetes Medications

Written by Corie Richter, PA

People with type 2 diabetes can take oral medications to help them control their blood glucose levels, and these medications work on the body differently. This article focuses on pramlintide and exenatide, 2 recently-developed medications used to treat type 2 diabetes.

Diabetes Medications Background
While insulin is important, it's not the only hormone produced by the pancreas at the time of food ingestion; it's not the only hormone important in diabetes.

However, up until recently, the focus on controlling blood glucose levels in diabetics has been concentrated on adding insulin or attempting to stimulate its production.

These 2 medications this article focuses on—pramlintide and exenatide—were developed not to stimulate or mimic insulin. Instead, they work on or mimic other hormones produced by your pancreas.

Pramlintide for Type 2 Diabetes
is the manufactured replacement for the peptide hormone amylin. When the body releases insulin, it also releases amylin. Therefore, if your body isn't making enough insulin, it's probably having trouble making amylin, too—and amylin also helps lower blood glucose levels.

The hormone amylin reduces how much glucagon you have in your body; glucagon causes your body to produce or release glucose. So if the level of glucagon is reduced, then your blood glucose level goes down, too.

Pramlintide (brand name Symlin) gives the other hormones an opportunity to take effect and lower the blood glucose level before it rises to abnormal levels. It also slows how quickly food is absorbed, and it makes you feel full sooner. All this helps lower your blood glucose level.

Studies found that pramlintide users had a modest reduction in A1c levels, and they did not have an increased risk of hypoglycemic episodes. Some even experienced some weight loss.

Pramlintide cannot be mixed in the same syringe as insulin.

Currently, pramlintide is recommended for people with either type 1 diabetes or type 2 diabetes on insulin who cannot control their A1c with insulin alone.

The down side to this diabetes medication is that many patients suffer from nausea with the initial use, which may take some time to resolve. It is not indicated for those with digestive problems such as diabetic gastroparesis, which is when the stomach does not empty in a timely fashion.

Exenatide for Type 2 Diabetes
(brand name Byetta) is an analog (man-made synthetic) of the glucagon-like peptide 1 (GLP-1) hormone. GLP-1 is released by your digestive tract when you eat, and part of its job is to keep you from eating too much. When it's released, it's a signal to your body that you're "full." GLP-1 also suppresses glucagon as it stimulates insulin production.

Researchers created this synthetic version of GLP-1 from—interestingly enough—the saliva of the Gila monster. They found that there's a peptide called exendin-4 in the Gila monster's saliva that works like GLP-1, so using that, they were able to create this analog.

Exenatide will not stimulate insulin production in the absence of hyperglycemia so it will not be a source of hypoglycemia unless you're also taking a sulfonylourea.

Exenatide users have experienced weight gain. Similar to pramlintide, people with type 2 diabetes using exenatide often complain of initial nausea.

Type 2 Diabetes Medications Summary
People with type 2 diabetes have many medication options. Talking to your doctor about the options—including the side effects—will help you make a good decision for your health.