Instructions

GLP-1s:

GLP-1 injectibles work in a number of ways to improve postprandial glucose levels: they improve pancreatic insulin secretion (in type-2 diabetes), blunt glucagon production, slow gastric emptying and inhibit appetite. All of these combine to reduce glucose excursions following meals. Side effects include mild nausea. But with proper dosage titration, this can be minimized.

- subcutaneous injectable hormone

+ enhances 1st & 2nd phase insulin secretion

+ slows gastric emptying

+ suppresses appetite

- may cause nausea

Amylin Analog:

Remember, amylin is completely lacking in people with type-1 diabetes, and partially lacking in those with type-2 diabetes. Amylin’s primary function is to slow digestion and regulate the appearance of glucose in the bloodstream following meals. The amylin (pramlintide) hormone can be taken directly at mealtimes to greatly suppress gastric emptying and suppress hunger. However, amylin commonly causes nausea and requires multiple injections daily, so the benefits must be balanced against the drawbacks. Note that amylin is the only non-insulin medication approved for the treatment of type-1 diabetes.

- subcutaneous injectible hormone

+ enhances satiety

+ slows gastric emptying

+ suppresses post-meal glucagon secretion

- may cause nausea

The Effects of Pramlintide on Gastric Emptying in Type-1 Diabetes

Pramlintide slows gastric emptying of the solid portion of a standard meal in subjects with type 1 diabetes.

Gastric emptying is the rate-limiting step that regulates glucose delivery from the GI tract into the bloodstream.

The effects of pramlintide, seen at the first meal, were no longer present at a subsequent meal. This is why amylin injections must be given prior to each meal in order to see the benefits throughout the day.

Slowing Food 7: Avoid Pre-Meal Hypoglycemia

Hypoglycemia prior to meals causes accelerated gastric emptying, which often leads to significant glucose spikes. This can be seen following mild hypoglycemia or instances when the glucose is normal but falling rapidly. Prevention of hypoglycemia going into meals can help avoid this “rebound high” situation.

Hypoglycemia produces “Sieve Effect”

The lower the glucose, the faster the gastric emptying

Produces more rapid BG rise after meal

Speeding Insulin 1: Choice of Bolus Insulin

Given that most food cause blood glucose to start rising within minutes of consumption, it is necessary for insulin to be present as early as possible. As far as making sure insulin is working as soon it is needed, the choice of insulin can have a major impact. Replacing regular (R) insulin with rapid-acting insulin analogs such as aspart, lispro and glulisine can make a significant difference due to their earlier onset of action and peak times.