Injectable, Non-Insulin Medications for Type 2 Diabetes
When diet, exercise, and metformin are not enough to manage type 2 diabetes, physicians might recommend a non-insulin injection medication to help control blood sugar.
An Injectable For Type 1 or 2 Diabetes
Pramlintide, or Symlin, can be prescribed for type 1 or 2 diabetes. It is similar to a naturally occurring human hormone called amylin, involved with glucose control.
Pramlintide prevents after meal blood sugar levels from spiking by slowing down the movement of food through the stomach. It also lowers glucose production in the liver. This medication may reduce appetite and can stimulate weight loss. Taken prior to meals, it sometimes causes nausea, so starting with a low dose is recommended.
Though it can be used with insulin, pramlintide must be given as a separate injection—not mixed with insulin in the same syringe. It may increase the risk of insulin related hypoglycemia, especially in those with type 1 diabetes.
Injectables for Type 2 Diabetes
The injectable medications for type 2 diabetes are “GLP-1 agonists.” The letters GLP stand for Glucagon-Like Peptide, a human hormone. An agonist is a substance that triggers a biological response when it binds to a receptor on a cell.
So, GLP-1 agonists are substances so similar to the GLP-1 hormone, they bind to the GLP-1 receptors located in our heart, brain, fat, kidneys, liver, blood vessels, and pancreas—triggering a biochemical reaction.
When GLP-1 agonists bind to GLP-1 receptors in the pancreas, more insulin is released by the pancreas while glucagon secretion is suppressed. This causes a reduction in blood glucose levels. GLP-1 agonists can also stimulate weight loss (two to ten pounds in three months) and do not trigger hypoglycemia.
The reason GLP-1 agonists must be injected is that, like insulin, they are proteins. If taken orally, they would be digested in the stomach.
Going by the brand name Byetta, exenatide (a twice daily injection) works by improving insulin secretion when blood sugar is high and simultaneously decreases the liver’s glucose production. It might help reduce appetite, but may also cause nausea or vomiting.
When taken with a sulfonylurea (a diabetes medication that helps the body manufacture insulin), there is increased risk of hypoglycemia—the sulfonylurea dose may need to be lowered.
Exenatide is also available in extended release form, brand name Bydureon. The active ingredient is embedded in biodegradable spheres that slowly dissolve to release the medication. Injected once per week, it works the same way as regular exenatide and raises the risk of hypoglycemia when taken with sulfonylureas.
Exenatide was initially discovered in Gila monster venom. (Gilas are large lizards that thrive in the arid areas of southwestern U.S.) It is not an insulin substitute, and is not recommended for use with insulin.
With an upbeat brand name of Victoza, liraglutide is a once daily injection that stimulates the production of insulin while simultaneously suppressing glucose output from the liver. Some people on liraglutide experience nausea with initial doses that may ease or disappear over time. Your doctor may recommend regularly checking your pancreas function through blood work if on liraglutide.
Also called Tanzeum, albiglutide is a once weekly injection that along with diet and exercise treats type 2 diabetes. It can be used with insulin but should never be mixed with insulin in the same syringe, or injected simultaneously into the same body area. Albiglutide, exenatide, and liraglutide come with a warning about increased risk for thyroid tumors, including cancer, so family history needs to be considered carefully.