Incretin Mimetics

We now have a way to administer GLP-1 directly, albeit by injection. Byetta and Victoza are available in pen form; the pen needles are very small and virtually painless. Byetta is taken twice daily; Victoza once daily, Bydureon, once weekly.

Incretin Mimetics are the only diabetes medications that improve glucose control while simultaneously promoting weight loss.

Amylin Analog

Pramlintide mimics the action of the hormone amylin, normally co-secreted by the pancreas along with insulin. In people with type-2 diabetes, amylin levels are abnormally low. Unlike Byetta and Victoza, which are not FDA approved for use with mealtime insulin, Symlin is intended for use by people taking multiple insulin injections. Its effects are similar to those of Byetta and Victoza, using a slightly different mechanism (via the central nervous system), and without enhancing the growth or production of pancreatic beta cells.

Insulin Action Profiles

When insulin is required to control type-2 diabetes, there are several options to choose from.

The rapid-acting analog insulins (aspart – brand name Lispro; glulisine – brand name Apidra; and lispro – brand name Humalog) begin working approximately 15 minutes after injection, peak in 60-90 minutes, and dissipate in 3-5 hours.

Intermediate-acting insulin (NPH) begins working in 1-2 hours, peaks in 4-8 hours, and dissipates in 12-16 hours.

Long-acting/basal insulin detemir (brand name Levemir) has a broad duration of action (18-24 hours) with a mild peak in 6-12 hours. It is usually taken twice daily to produce a relatively flat insulin profile throughout the day.

Long-acting/basal insulin glargine (brand name Lantus) is a peakless insulin that lasts 22-24 hours.

Why the need for so many different insulin types? Well, let’s take a look.