It seems obvious that cutting away part of the stomach and intestine should cause weight loss. With a smaller stomach and less intestine fewer calories can be absorbed per day causing weight loss. Surgeons who perform gastric by-pass were puzzled however, by how fast their patients showed metabolic improvement after undergoing this procedure. They noticed many of their diabetic patients could be taken off diabetic medication immediately after surgery before weight had been lost. Scientists looking into this phenomena discovered unsuspected ways gastric by-pass improved metabolism.
The intestines produce hormones which regulate blood sugar and appetite. GLP-1 is among the best known of these intestinal hormones. GLP-1 is the basis of a whole new generation of medications used to treat diabetes such as Byetta, Victoza, Januvia and Onglyza. GLP-1 lowers blood sugar, stimulates the pancreas and reduces appetite. After gastric by-pass increased amounts of GLP-1 are produced by the remaining intestine. In a study published in the Journal of Clinical Endocrinology and Metabolism (95:4072-4076, 2010), researchers at St. Luke’s Hospital in New York discovered that levels of oxyntomodulin, another intestinal hormone that suppresses appetite and acts like GLP-1 on blood sugar levels, is doubled after gastric by-pass.
These exciting discoveries help explain why obese diabetics can often be sent home without any medication to control blood sugar immediately after undergoing gastric by-pass surgery. Although most insurance plans do not cover gastric by-pass surgery, dramatic improvements in patients after the procedure with greatly reduced medication costs may convince insurance companies that paying for the procedure will result in better outcomes and save them money in the long run.
Al is a type 2 diabetic. He has learned a lot about how diet and exercise can influence his blood sugar but still has frustrations with treatment options. He shares his thoughts with metabolism.com:
I am a male 47 years of age. 2 years ago my A1C was at 9.9 i was eating horribly and not exercising. Now my diet consists of South beach diet phase 2 my A1C is now 6.5 and my sugars are between 80 to 130 . My exercise routine is every other day due to my weight I am 5′ 7 1/2 lbs and at 282lbs my back is killing me.
I understand that there needs to be a lot of testing for these things and rightly so. Ive noticed that there is some hazards with Byetta and am glad im not on that and on avandia. I must point out that with the problems diabetics already have we do not need to compound it with more even though I do wish the testings would some how be able to go faster and that more and more research is done with stem cell testing.
My next option is to go for bariatric surgery..but my insurance wont cover it.
So here i am at a catch 22 . I hope they come up with something soon.
I am a male 47 years of age. 2 years ago my A1C was at 9.9 i was eating horribly and not exercising. Now my diet consists of South beach diet phase 2 my A1C is now 6.5 and my sugars are between 80 to 130 . My exercise routine is every other day due to my weight I am 5′ 7 1/2 lbs and at 282lbs my back is killing me.
I understand that there needs to be a lot of testing for these things and rightly so. Ive noticed that there is some hazards with Byetta and am glad im not on that and on avandia. I must point out that with the problems diabetics already have we do not need to compound it with more even though I do wish the testings would some how be able to go faster and that more and more research is done with stem cell testing.
My next option is to go for bariatric surgery..but my insurance wont cover it.
So here i am at a catch 22 . I hope they come up with something soon.
A new group of medications has recently become available for the treatment of type 2 diabetes. These medications take advantage of discoveries on the workings of hormones naturally made by the intestines known as incretins. These hormones are made by special cells in the intestine in response to eating. Incretins stimulate the release of insulin from the pancreas and insulin enters the circulation where it regulates the amount of sugar in the blood. Some incretins also stop the release of glucagon which is another hormone which interferes with insulin action.
The first of these medicines receiving FDA approval is exenatide (Byetta). Byetta is given by subcutaneous injection twice daily just before eating. This medicine appears to have a secondary benefit of reducing appetite and assisting with weight loss efforts.
Sitagliptine (Januvia) is another FDA approved medication taking advantage of the incretin system. It is an oral medication taken once daily and has been shown to be effective at lowering blood sugar levels in type 2 diabetics.
These prescription drugs should only be used with the advice and monitoring of your health care professional.
A cure for type 1 (juvenile) diabetes is still a distant hope. The main focus for curing or delaying type 1 diabetes focuses on the immune system. The immune system normally protects us against viruses, bacteria and cancer cells. In type 1 diabetes a person’s own immune system appears to attack the insulin producing cells in the pancreas leading to the disappearance of this vital sugar controlling hormone. Studies in humans are now taking place which use artificially created antibodies to stop this immune attack on the pancreas. Using these experimental substances, delays of up to 18 months in the onset of type 1 diabetes have been achieved. Many more studies of this type are being planned hopefully paving the way for even better results.
I just returned from a conference on the latest wonder drug to be launched in the battle against diabetes Type 2 diabetes (the kind treated with pills, not insulin injections). The drug, brand named Byetta,(exenatide), is a derivative of a compound in the saliva of the Gila Monster. These ugly and venomous lizards eat 3 times per year. How about that for metabolism? Helping them accomplish that is a chemical in their digestive tract that turns insulin production on when needed. The scientific name of this naturally occurring substance is glucagon-like-peptide 1, or GLP-1, for short. Since diabetics don’t make enough insulin this wonder drug is ideal for helping them get more of what they need.
As if that isn’t enough, Byetta (the synthetic version of the compound in Gila Monster spit) turns off feelings of hunger. What is the result in humans? You guessed it,… weight loss. Not just routine weight loss but a weight loss that keeps on going and going and going. In one preliminary study the weight loss continued for up to 82 weeks.
Is there a downside to all this? Certainly. First of all, the medicine must be self administered as an injection twice a day. Second, some people experience nausea or constipation using Byetta. The degree of unpleasant gastro-intestinal symptoms produced by this novel medicine will likely determine how wide spread its use will be. One wonders if it could become the next blockbuster drug.
Byetta is marketed by Amylin Pharmaceuticals and Eli Lilly Company and is available by prescription only. If you suffer from Type 2 diabetes you may want to ask your doctor if artificial lizard spit is right for you.
The mission of the The Thyroid Project is to encourage sharing of information and experience between the public and the medical community about the treatment of hypothyroidism (low thyroid function). For at least the past few decades there is a growing awareness of “something missing†in the way suffers of hypothyroidism are treated for their disease.
Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors.
Without effective intervention the early stage of type 2 diabetes known as prediabetes carries a high risk of progressing to outright diabetes. Metabolism.com provides an up-to-date summary of recommendations from national authorities, for preventing and possibly reversing this life long affliction
Diabetes can be defined simply as elevated blood sugar levels. What exactly is high blood sugar and when should someone be concerned about their level? Does having prediabetes mean diabetes is around the corner? Metabolism.com tackles this tricky but important topic in this comprehensive review.
By Gary M. Pepper, M.D. Ozempic, Rybelsus, Trulicity, Wegovy, Saxenda are the central players in the weight loss craze sweeping across the globe. Metabolisim.com has been monitoring this phenomenon from its beginnings in 2008 with its report “Lizard Spit Reduces Blood Sugar and Appetite”, regarding the first drug in this class, Byetta (exenatide). Caught In the middle of the current chaos are the medical experts who treat diabetes and have been prescribing these medications for more than a decade. Here is a brief commentary from one such board certified endocrinologist; “I started treating Type 2 diabetics with GLP-1 agonists more than 10 years ago. In some respects, these medications have revolutionized the treatment of diabetes by lowering blood sugar effectively and promoting weight loss at the same time, a unique combination of benefits. Not everyone benefits from these drugs to the same degree unfortunately, and I have seen lots of patients experience unacceptable side effects from them. Nothing though, has prepared me for what is happening now. Too often, I find myself confronting someone who expects me to prescribe one of these drugs just so they can lose weight. Sadly, one extreme example was someone who, despite battling a life threatening medical condition, was insistent on getting a prescription. At the same time my diabetic patients are scrambling to find a place to buy their medications if they can even afford it. It is disheartening, to say the least, and I dread the negative interactions with some of my patients I now face almost daily.”
Off- Label Use
The FDA is the U.S. government’s department tasked with evaluating and approving drugs for specific medical conditions. When a new medication is approved for treating a medical condition by the FDA the agency will, at the same time, set strict guidelines for exactly which patients may use the newly approved drug. When a medication is used “off-label” it means that these limitations are being overridden by the provider for a potential benefit which outweighs the drugs risks. It is a general misconception that off-label means illegal; it does not. This practice has been going on for ages and more than 20% of prescriptions in the United States are prescribed off-label. A common example is the use of beta-blockers (approved for heart problems) for the treatment of performance anxiety.
GLP-1 agonist drugs, as discussed recently by metabolism.com. were originally approved for the treatment of Type 2 diabetes in adults. In the past few years most of these same medications have gained unprecedented popularity for their “off-label” weight loss benefit. Of the 5 GLP-1 agents presently in U.S. pharmacies only Wegovy (semaglutide) and Saxenda (liraglutide) are FDA approved for treating obesity. Of these two, Wegovy is the newer and had been much more popular that its sister drug Saxenda, probably due to being dosed only once weekly compared to daily for Saxenda and less likely to cause side effects. Due to Wegovy’s soaring popularity, its manufacturer, Novo Nordisk, increased the price of Wegovy two times since its initial release.
