Welcome to our video on injectable
Now, first, we're going to start
with the incretin mimetics.
We have both the exenatide
and the extended release.
Remember, anytime you see
"extended release" after a drug,
that means it's going to last for a long time.
Now, this is for type 2 diabetics only.
Currently, there is some off-label use
for type 1, but for now, remember,
use sue this for type 2
diabetics only, officially.
Now, amylin mimetics, we've got pramlitinide.
Type 1 and type 2 who use mealtime
insulin can benefit from this one.
So it's not an insulin, but
it is an injectable drug.
So, incretin is officially only used for type 2s.
Amylin mimetics are used for type 1
and type 2 who use mealtime insulin.
So, let's dig in a little deeper and
look at the incretin mimetics first.
They're also known as GLP-1 receptor agonist.
Now, I know it's getting very difficult
to keep all these letters straight.
Incretin mimetics is a much
better name for you to remember,
but just keep in mind there's a receptor involved.
So it might help you if you just write the word
"receptor agonist" underneath
the incretin mimetics.
Now, these drugs enhance the effects
of the hormone incretin, right?
That's why we mimic that drug.
So after you eat, normally, GLP-1 is one of the
incretins that's released in your GI cells.
So, in your body, when you eat, these
GLP-1s are released from your GI cells,
and that's what slows down the gastric emptying.
It stimulates the release of
insulin, so that helps your body,
kind of, drag that glucose out of
the bloodstream into the cells.
So, GLP-1 responds to an increased
glucose after you've eaten.
It also inhibits the release of glucagon,
and it will suppress appetite.
This is a pretty impressive drug.
I mean, you have to stick yourself to take
it, but why would this benefit a patient?
Well, we're going to end up
with a lower blood sugar.
That's what we're looking for,
but how does it get to that?
Well, look at your graphic.
They did a really good job of
shortening this down for you.
Look at all the arrows that are
going down, except insulin,
because the goal is with these medications,
that we want to lower blood sugar.
So look at that first arrow.
It slows down gastric emptying, so
things will move through slower.
Stay tuned, that's probably going
to give us some problems later.
Glucagon is suppressed.
That's the hormone that tells
my liver to put out more sugar.
That's good if I want to lower blood sugar.
It will suppress appetite.
Hey, that's kind of a new one.
But remember, we're messing with gastric
emptying and that very complex process,
so that's why we can suppress appetite.
It will stimulate insulin.
That's going to help us lower blood sugar.
So, if a bunch of words seem overwhelming, they've
got a great graphic there for you to remember.
But I don't want to move on until
we address delayed gastric emptying
because that could impact your
patient's other medications.
When the gastric emptying is slowed, it might
impact the absorption of oral medications.
So, if the patient is on other oral medications,
as a healthcare provider team,
you're going to need to look at the timing of
an incretin mimetic with other medications
because that could significantly effect.
Now let's look at the adverse
effects of an incretin mimetic.
They can have a headache.
Boy, lots of drugs can seem to cause that.
They might have a possible
risk of thyroid cancer.
That's something unusual.
This is the one that you absolutely
have to know on this medication,
is that there is a risk for hypoglycemia.
It really would be a good idea, as
you're going back through your notes,
make sure that you have 1 complete list
of all the anti-diabetic medications
that have a risk for hypoglycemia.
That's critically important that you
know that as a healthcare provider.
Now, because this delays gastric emptying,
the patient might have some GI distress.
Also, there might be a slight
risk of renal insufficiency.
But the absolute have-to-know on this
slide is the risk for low blood sugar.
That means you need to know
the signs of low blood sugar,
you need to teach your patient
the signs of low blood sugar,
so they know how to intervene.
So, absolute must, the hypoglycemia risk.
And make sure you take the time
to go back through your notes
and make a list of all the medications
that have the risk of hypoglycemia.
Let's supercharge your memory
and see what you know.
Which medication that we discussed
that slows down the breakdown of
incretin by the enzyme DPP-4?
I gave you some clues in that one.
Let's see how you did.
The answer is DPP-4 inhibitors.
That's another one of the classes or
families of oral anti-diabetic medications.
They slow down the breakdown
of incretin hormones
by blocking the action of the enzyme, DPP-4.
Now, let's look at the amylin
That's one of them.
It's a peptide hormone, so an amylin
in my body is another hormone.
It delays gastric emptying.
Before we ever start, think
through what you already guess
are going to be the side
effects of an amylin mimetic.
Look at that mechanism of action.
Does it look familiar?
It delays gastric emptying.
It suppresses your appetite.
It suppresses glucagon,
and it increases insulin.
What does that sound like?
What does that graphic look like?
Yeah, this is awesome.
When you look at these things,
the effect in the body is very similar
to the drugs we've just discussed.
Now, the interesting part is that
appetite suppressing in the brain.
That's a really cool side
effect for these medications,
and it may help the patient get
their weight under control.
This one also has a risk of hypoglycemia,
particularly when it's used with insulin.
So, you're going to have the same
kind of GI distress with this one,
just like the incretin mimetics.
So, these guys, their side effects are
going to be fairly easy to keep in mind,
because you've got this great
graphic to help remind you,
they both slow gastric emptying,
they both suppress appetite,
they both suppress glucagon,
and they increase insulin.