Symlin and Byetta: Two New Drugs Join the Battle Against Type 2 Diabetes

In 2005, the United States Food and Drug Administration approved two new drugs from Amylin Pharmaceuticals, Inc., a newcomer to the pharmaceutical scene, for use in the fight to control diabetes.� Symlin® (pramlintide acetate) and Byetta® (exenatide) are injectable medications that mimic the body's natural hormones that help control blood sugar levels.� Symlin is a replacement for amylin, a pancreatic hormone, while Byetta mimcs the action of exendin-4, a hormone that interacts with glucagon-like peptide-1 (GLP-1) in the body to help regulate blood sugar.� The use of medications that mimc the body's natural hormones is an exciting new development in diabetes treatment that promises more effective blood sugar control without weight gain or potential liver damage.

Symlin

When a person's pancreas functions normally, it secretes two hormones that are very important for maintaining proper blood glucose levels.� As blood sugar levels rise after meals, insulin acts to move glucose into the muscles and organs for their use as an energy source.� Amylin, released in response to the rise in blood sugar, acts as a brake on the system by telling the liver to slow down its conversion of its stored glucagon into glucose.

In Type 2 diabetes, this system runs out of control.� The pancreas is unable to produce enough insulin or amylin, or any at all.� The liver has no way to know when to stop and blood sugar levels rise out of control.

Symlin replaces the missing amylin, helping the body's metabolism to regulate itself in a more normal manner.� This reduces or eliminates the blood glucose peaks after meals and snacks that are so troublesome for diabetics.� The cumulative effects of these hyperglycemic peaks cause damage to the nerves, eyes, kidneys, and cardiovascular system.�

Since Symlin is used as an adjunct to insulin therapy, one of its benefits is a reduction in insulin dosages.� Symlin may also suppress appetite to some extent by helping the body to regulate itself better, reducing the demand for glucose.

Symlin is only appropriate for use by diabetics who already use insulin.� Balancing the doses of Symlin and insulin requires careful attention to blood sugar levels.� Only patients who will follow their doctor's directions carefully and maintain contact with their doctor should take Symlin.� The combination of Symlin and insulin can lead to severe hypoglycemia, so it is not appropriate for use by those who are hypoglycemia-unaware.

Symlin is injected under the skin in the same way as insulin, using a U-100 insulin syringe.� The down side of this is an increase in the number of injection required.� Future advances in insulin dosing via inhalation or epidermal patches may also be applicable to Symlin, which would mitigate the pain and inconvenience of injections.

Type 2 diabetics who are interested in exploring Symlin therapy for better blood sugar control should discuss the implications and potential side effects with their physicians in detail.� Balancing insulin and Symlin dosages requires careful attention to testing and diet over time.� Symlin users should be prepared to deal with severe hypoglycemia at any time.

Byetta

Byetta is the first drug released in a new class called incretin mimetics.� Byetta is a synthetic hormone that is a version of exendin-4, a naturally occurring hormone that is part of the body's system for self-regulating blood glucose levels.� It is not intended as a substitute for insulin therapy.

When blood glucose exceeds optimum levels, Byetta stimulates the pancreas to excrete more insulin, as blood glucose levels drop, it suppresses insulin production.� This system levels off blood glucose levels and helps prevent large peaks (hyperglycemia) and valleys (hypoglycemia.).� Byetta also acts to slow down stomach emptying and helps create a feeling of fullness that decreases appetite.� A pleasant potential side effect is weight loss.

Byetta is intended for use by Type 2 poorly-controlled diabetics already taking metformin or a sulfonyurea.� Byetta may assist these patients in reaching good control of their blood sugar levels.

Since Byetta is a hormone, like Symlin, it must be injected.� Also like Symlin, administration of Byetta may become easier in the future as alternatives like sprays or patches are developed.��� It comes in pre-loaded pen injectors and is injected subcutaneously, just like insulin and Symlin.� Byetta should be taken twice per day within an hour before a meal.

Since Byetta enhances the effects of metformin and sulfonylureas, hypoglycemia is always a danger.

Symlin and Byetta are just the first synthetic hormones to be released.� As research continues, the body's self-regulatory mechanisms will be better understood and new treatments will be forthcoming.� These treatments have significant advantages over traditional diabetes treatments, such as fewer side effects, and far less danger of liver damage.� These two drugs are ushering in a new age for diabetics that gives the hope of effective treatment that works in harmony with the body's existing systems to eliminate the effects of the disease.