The word HOPE means different things to different people. We may hope it won't rain tomorrow but we have very little control over that, but if we hope to have no hypoglycaemic reactions playing pickleball then we do have control over that particular hope. If we look in the dictionary to define the word it comes up with several options depending if you use it as a verb or a noun.
When we hope, we are more or less seeking positive outcomes with respect to an event or something we want to happen. When used as a verb we are expecting something with confidence.
Today, I am going to discuss some new trends (drugs, procedures,) that offer us HOPE by improving control of our blood glucose values. For me, I hope these new developments will bring positive outcomes for those of us now and for future generations.
New drug for people with Type 2 Diabetes (highlights)- approved for use in conjunction with diet and exercise for people with type 2 diabetes
Tirzepatide- approved by the FDA (not in Canada yet) in May, 2022.
It is once a week subcutaneous injection
Solution is clear and colourless to a slightly yellow Available as many different strengths.
Never to be mixed with any other insulin you may be using.
For those who might be taking two different insulin injections, then do not inject adjacent to each other, but you can use the same body region (remember this new injection is only once a week).
If you have to change the day of the week, that is ok, but it must be at least 72 hours before you make the change. In other words if you had injected on Tuesday you cannot inject again on Wednesday. You must wait the three days (72 hours).
Refrigerate unused dosage forms.
Gradual tapering of dose upward is recommended. Single use pens may be kept unrefrigerated for 21 days as long as temperature does not exceed 30 degrees celsius (86 F).
OK to use if your kidney function is not 100% (each case must be individualized)
Not for use in pregnancy
Not for use in type 1 diabetes
Not to be prescribed for weight loss (see below)
Adverse effects:(not all listed)
Appetite decreases ( helps to lose weight in some individuals) (5-11%)
Nausea/diarrhea (12-19%)
Heartburn, vomiting (5-8%)
Abdominal discomfort, constipation (5-7%)
Risk of hypoglycemia especially if it is combined with a basal insulin
As with any medication there are always going to be adverse effects, some more serious than the others. This drug is no exception, so be sure to know what they are before agreeing to use this drug. Ask your medical provider, pharmacist or Diabetes Educator for clarity on adverse effects. Be sure to include all you medications, prescribed or not, when talking to your health care provider.
Don't forget to inquire about any possible interacting drugs that could either increase or decrease the effectiveness of this new drug or any of your current medications. Since the drug delays stomach emptying, oral absorption of some medications could be affected especially those that have a very narrow safety margin, for example, warfarin (an anticoagulant). Patients using oral hormonal contraceptives should add a barrier method of contraception for 4 weeks after initiation and for 4 weeks after each tirzepatide dose escalation.
Tirzepatide is a combination of two different glucose lowering drugs and is sometimes referred to as a dual action drug. One ingredient promotes insulin secretion in response to a meal which facilitates the breakdown of the foods we eat. The other ingredient increases insulin secretion when the blood glucose levels are high, slows down gastric emptying which will delay post meal glucose rise and decreases the secretion of glucagon (this raises blood glucose).
The drug's value comes in lowering fasting and post meal glucose concentrations, decreasing food intake and reducing body weight, all which can improve blood glucose control.
A more complete listing of the drug's pros and cons can be found at this site. Please keep in mind that since the drug has not been approved in Canada the indications for use and a slightly different monograph may exist once approval has been granted. Many times I have seen different types of approvals with different indications for use between USA & Canada and maybe some European continents.
Beta Cell Therapies for type 1 diabetes
Type 1 diabetes is an autoimmune disease which means that our own bodies attack the insulin-producing cells (ie. beta cells) in our body. As time goes on, none of these beta cells will function and therefore no insulin is produced in our body.
Researchers are focusing on treatment called "beta cell therapies" with the aim of either replacing the beta cells or regenerating (regrowing) beta cells. For replacement of beta cells, new healthy beta cells would be introduced by means of a complete pancreas or pancreatic islet transplant. The regeneration or regrowth therapy focuses on the health and growth of existing beta cells.
These transplanted beta cells can still be attacked by our body's immune system and thus medicines ( immunosuppressants) that lower the body's ability to reject the transplant cells need to be taken that can lead to serious and long lasting side effects. One of the barriers to this theory is the limited supply of pancreas from human donors.
A newer area of research is concentrating on devising methods to protect the transplanted beta cells from the immune system, therefore eliminating the need to take immunosuppressant therapy. Research is being done on ways to encapsulate these beta cells as to provide protection from the immune system.
Beta-cell regeneration aims at trying to restore insulin-producing cells that are lost in type1 and type 2 diabetes. This is based on the science that the residual beta-cells have the ability to reproduce (proliferate), Stay tuned for more research and results on this type of therapy.
Even though we have no cure yet, research into the area of diabetes cure and management is strong. As people with diabetes, we will HOPE that over time, a cure will be found at least for future generations.
This is a film that I thought would be of interest to my audience. I am including the website.
The Human Trial follows a groundbreaking clinical trial that peels back the headlines to show the sweat, passion and sacrifice behind every breakthrough cure. This story tells us about the physical and financial burdens of type 1 diabetes. I saw where it has been praised in the New York Times and even Rotten Tomatoes ( a reviewer of movies and productions) rates it as a must to see.
Conference Reminders:
Diabetes Canada is hosting two virtual learning events in October, one for Type 1 and another for Type 2 diabetes patients and their families. Check the Canada Diabetes website for registration and to find out more about the speakers and topics that will be included.
Registration for type 2 : https://letsendt2diabetes.ca/en/
Registration for type 1: https://nolimitsconference.ca/
I hope you have found this blog interesting and have learned some new ideas for which we can hope will have positive benefits for diabetes patients now and in the future.
This blog provides information only and is not intended to replace any medical advice received from your health-care provider(s).
Stay safe and well. Until next time, take care. Please remember to subscribe to this blog.
I must thank my friend, M. Wallace for giving me permission to use her beautiful photograph of sunrise in Caissie Cape, NB.
#HOPEfordiabetes ##transplantfordiabetics . .