Your Guide to Treating Diabetes

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Advances in Non-Insulin Shots for Diabetes

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According to the Centers for Disease Control and Prevention (CDC), diabetes affects more than 30 million people in the United States, and of this group, 90 to 95% have type 2 diabetes. For many years, people with type 2 diabetes had to resort to insulin injections if diet, exercise, and oral medications failed to keep their blood sugar under control. But now, with the advent of non-insulin injectables, more treatments options exist. This is a significant advancement, since most people need to adjust or add to their diabetes treatment over time.

Understanding How Non-Insulin Shots Work

Your body uses glucose, or sugar, for energy. It gets glucose from the food you eat. When you consume food, the glucose from your meal is absorbed into your bloodstream. After a meal, when the levels of glucose in your blood rise, your pancreas releases a hormone called insulin to help move the glucose from your blood to your cells, where it can be used for energy. Any extra glucose is stored in your liver and muscles. Later, if your blood glucose levels get low, your pancreas releases a different hormone called glucagon. This signals your liver to send glucose back into your blood to restore your levels to normal. Normally, the body goes through this process regularly and keeps blood sugar levels balanced.

But if you have type 2 diabetes, your body doesn’t use insulin like it should, and your blood sugar levels can get dangerously high. Too much sugar in your blood can lead to serious complications, like damage to your kidneys, eyes, feet, and more. To prevent this, your doctor may prescribe medications that help keep blood sugar levels stable. Eventually, many type 2 diabetics will need to inject insulin to achieve this. But before insulin becomes necessary, diabetics can benefit from taking oral medications and newer non-insulin shots. There are two main classes of non-insulin injections: glucagon-like peptide 1 (GLP-1) receptor agonists and amylin analogs.

GLP-1 receptor agonists are essentially a man-made version of a hormone that’s produced by your intestines when you eat. It’s given as an injection into your arm, abdomen, or thigh. GLP-1 increases the amount of insulin and decreases the amount of glucagon coming from your pancreas, thereby lowering your blood sugar. It also slows down how quickly food moves out of your stomach, making you feel fuller for longer.  Examples of GLP-1 receptor agonists include:

  • Exenatide (Byetta, Bydureon)

  • Liraglutide (Victoza, Saxenda)

  • Dulaglutide (Trulicity)

  • Semaglutide (Ozempic)

  • Lixisenatide (Adlyxin)

Two GLP-1 receptor agonists are combined with insulin. These can be used for people who already take insulin but are having a difficult time controlling their blood sugar. These are:

  • Insulin glargine/lixisenatide (Soliqua)

  • Insulin degludec/liraglutide (Xultophy)

Possible side effects of GLP-1 injections include nausea, diarrhea, and headache. These usually subside over time. There is a slight risk for more serious complications such as pancreatitis and kidney failure. Thyroid tumors and cancer have been observed in clinical trials with mice.

There is only one amylin analog, pramlintide (Symlin), that is currently approved by the Food and Drug Administration (FDA). Pramlintide can be used for both type 1 and type 2 diabetes. It suppresses glucagon coming from your pancreas, so your liver doesn’t release glucose into your bloodstream. Like GLP-1 receptor agonists, it also makes you feel fuller for longer by slowing down food moving from your stomach.  Side effects include nausea, vomiting, and headaches.

Benefits of Non-Insulin Injectables

While insulin injections will always have a place in diabetes treatment, non-insulin shots have some desirable perks:

  • Some non-insulin injectables only need to be taken daily or weekly. Exenatide (Bydureon), dulaglutide (Trulicity), and semaglutide (Ozempic) are given as weekly injections. Liraglutide (Victoza, Saxenda) and lixisenatide (Adlyxin) are given as daily injections.

  • Certain non-insulin injectables aid in weight loss. Since many of the GLP-1 injections slow down your digestion of food and decrease your appetite, you may lose some weight as a result. Losing weight is also helpful for controlling blood sugar.

  • Non-insulin shots are less likely to produce hypoglycemia, or low blood sugar. When given alone, non-insulin shots generally do not cause your blood sugar to drop too low. However, if you also take insulin or oral medications for your diabetes, your doctor may need to adjust your dosage to prevent this from happening.

Diabetes is a lifelong condition, but it doesn’t have to get in the way of living your best life. New diabetes medications like non-insulin shots can make managing diabetes much easier and lead to better overall control of your disease, so you can live a healthier, fuller life.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Sep 20
  1. Diabetes: Non-Insulin Injectable Medications. Cleveland
  2. National Diabetes Statistics Report, 2017. Centers for
    Disease Control and Prevention.
  3. Other Injectable Medications. American Diabetes Association.
  4. Type 2 Diabetes Diagnosis and Treatment. Mayo Clinic.
  5. Update
    on Diabetes Technology. American Diabetes Association.

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