Good medical news: New pill approved to treat Type II diabetes

A new pill called canagliflozin is a “sweet” way to treat Type II diabetes.

The Food and Drug Administration (FDA) has approved the first of a new class of anti-diabetic medications. This medication helps patients with Type II diabetes control their blood sugar levels in a way that hasn’t been used before.

This new class of drugs, SGLT2 inhibitors (short for sodium-glucose co-transporter 2), acts to allow diabetics to release more glucose into their urine and thus decrease blood glucose levels. This medicine, recently approved by the FDA, is canagliflozin (Invokana is the brand name.) A similar SGLT2 drug is already in use in Europe.

The dangers of diabetes

Diabetes is a disease that causes affected patients to have problems with keeping their blood sugar (glucose) levels in the normal range. Elevated levels of blood glucose can cause multiple problems if untreated. They can range from cardiovascular disease leading to heart attacks or strokes, to loss of vision, neuropathic pain, vascular disease that may lead to amputation of limbs, coma and even death. It is estimated that around 25 million Americans are diabetic. And that number is constantly growing. So this class of medications could potentially benefit millions of people.

Diabetes via Shutterstock

Diabetes via Shutterstock

What is diabetes?

There are two major types of diabetes labeled Type I and Type II. Type I diabetes (which used to be called juvenile-onset diabetes or insulin-dependent diabetes) happens when the pancreas is unable to produce insulin (a hormone necessary for most cells to be able to utilize glucose.) Type I diabetes needs to be treated by insulin injections.

Type II diabetes (formerly called adult-onset diabetes or non-insulin dependent diabetes) is a disease that causes the body’s cells to become resistant to the effects of insulin. Often Type II diabetes is treated with oral medications. These oral medications work by different mechanisms to help get blood glucose levels back to normal. These mechanisms include: acting on the intestine to help prevent the absorption of glucose into the blood, reducing insulin resistance by the liver, reducing insulin resistance by muscle and fat tissue and others.

The new SGLT2 inhibitor medications work with the normal kidney physiology to get rid of excess glucose.

How the new drug canagliflozin works

Briefly, urine normally gets made like this. The kidney filters blood that passes through it. Many chemical compounds get filtered out into the fluid that will become urine. Things like salts and other ions, urea, glucose and other relatively small molecules. A little later on in the process, the kidney reabsorbs the things that it deems valuable (some ions, glucose, etc.) and lets the remaining waste continue to move on and become urine.

So people with normally functioning kidneys, who don’t have diabetes, will essentially have no glucose in the urine that they produce. However, as the blood sugar rises above a certain limit, the kidney, as efficient as it is, becomes overwhelmed and can’t reabsorb all of the glucose. So some begins to spill out into the urine. Before the development of the current finger stick blood glucose analyzers, diabetic patients tested their urines for glucose. That gave them an idea of how high their blood glucoses were. The higher the blood glucose, the more glucose in the urine. The SGLT2 inhibitors act to block the reuptake of glucose. As a result, more glucose is allowed to spill out into the urine, and the blood glucose decreases.

Canagliflozin’s side effects

Like all medications, this one has side effects. Women taking it seem to experience a higher incidence of vaginal yeast infections, and both sexes are at increased risk for urinary tract infections. Also, it slightly increases both good and bad forms of cholesterol. There may be a slightly increased risk of stroke and heart attack for some patients. Though the FDA isn’t sure of the significance of the stroke and heart attack data.

But it also has good side effects. One is it promotes mild weight loss (some other anti-diabetes medications promote weight gain.) Another is that it also acts to lower blood pressure. Some other anti-diabetic medications can cause hypoglycemia, a condition where the blood sugar gets too low. This can cause the patient to develop a variety of symptoms while hypoglycemic (confusion, a feeling of shakiness, anxiety, sweating and others.) Canagliflozin doesn’t seem to produce hypoglycemia.

As with almost all new drugs, it will be fairly expensive, probably costing nearly $300/month for the daily dose. However, once the drug gets placed on insurance company formularies, the insured patients will only have the co-pay to worry about.

Why as a doctor I’m excited about Canagliflozin

This medication may be very useful for some Type II diabetics. Some are currently on multiple medications daily. Some fraction of those might be able to be switched over to a SGLT2 and get off of some other medications. Others who are having problems with weight loss, might benefit from being placed on this, either as a single medication or as part of a combination.

With diabetes being a widespread disease, causing much morbidity and contributing to many deaths, new, effective drugs are always welcome.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • Dr. Burns

    New research indicates that certain supplements can work
    well with Metformin to decrease blood sugar, cholesterol and blood pressure.
    Biotivia Transmax which is a natural resveratrol has been clinically proven to
    work according to The Journal for the American Heart Association:

    http://www.worldhealth.net/news/resveratrol-recommended-adjuvant-therapy-typ

  • Helen D. Mazzariello

    It’s good to know that people with diabetes have different alternatives to help them treat their illness. I know these days, there are really many different ways that are cheaper, safer and more effective. It’s good to know that they can actually choose from a variety that could benefit them the most.

    http://sunrisemedresearch.com/

  • StanfordLongevity

    Given your a priori conviction that your patients will not adhere to a program of constructive lifestyle modifications it is hardly surprising that you fail to even prioritise this extremely efficacious, safe, and healthy option or counsel your patients on its advantages.

  • StanfordLongevity

    This review you cite is dated, to say the least. The majority of clinical trials are not even addressed in this paper. A more comprehensive and updated review, focused specifically on the modes of action of resveratrol vis-a-vis Diabetes, and an appraisal of the scientific literature, will be published in a major European endocrinology journal after the first of the year. You should also be aware that the chemo-protective effects of transmax resveratrol are by no means limited to its attenuation of the pathologies related to Type 2 Diabetes. They extend to cardiovascular disease, carcinogenesis, blood lipids, mitochondrial function, and much more.

  • StanfordLongevity

    You mentioned toxicity as an issue with resveratrol. There is, in fact, no clinical evidence in the scientific literature or FDA adverse effects reports which support your speculation. On the other hand, Exenatide has an FDA black box warning which derives from evidence that this drug may increase thyroid cancer risk. It has also been linked with a possible increase in pancreatic cancer risk.

  • StanfordLongevity

    A Pubmed on “resveratrol diabetes” search will return 341 published articles, virtually all of which will confirm my analysis of the compound’s vlaue as a chemo-preventative agent and as a potentially safe and effective treatment for Type 2 Diabetes. Thanks for asking.

  • StanfordLongevity

    Evidently you missed the below investigations of Resveratrol’s anti-diabetic properties in your selectively negative appraisal of this compound:

    1. Effects of resveratrol on nerve functions, oxidative stress and
    DNA fragmentation in experimental diabetic neuropathy.

    Life Sci. 2007 Mar 6;80(13):1236-44. Epub 2007 Jan 20.
    Kumar A, Kaundal RK, Iyer S, Sharma SS.
    Molecular Neuropharmacology Laboratory, Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Sector-67, S.A.S. Nagar, Punjab-160062, India.

    Conclusion: Results of the present study suggest the potential of
    resveratrol in treatment of diabetic neuropathy and its protective
    effect may be mediated through reduction in oxidative stress and DNA fragmentation.

    2. Antihyperglycemic Effects of Short Term Resveratrol
    Supplementation in Type 2 Diabetic Patients

    Ali Movahed,1 Iraj Nabipour,1 Xavier Lieben Louis,2,3,4

    Sijo Joseph Thandapilly, Liping Yu, Mohammadreza Kalantarhormozi, Seyed Javad Rekabpour, and Thomas Netticadan

    Heart Failure Research Laboratory, Canadian Centre for Agri-Food Research in Health and Medicine,
    St. Boniface Research Centre, Winnipeg, MB, Canada R)H )A&

    Agriculture and Agri-Food Canada, Winnipeg, MB, Canada R’T )M*

    Department of Physiology, University of Manitoba, Winnipeg, MB, Canada

    Conclusions: The results of this study clearly demonstrate that resveratrol supplementation in the presence of standard antidiabetic
    medication has major benefits in T2DM patients, which
    include; a pronounced lowering of blood glucose, HbAc,
    insulin levels, and insulin resistance, as well as improvement
    in HDL levels (Figure 1)

    2. Grape Polyphenols Prevent Fructose-Induced Oxidative Stress and Insulin Resistance in First-Degree Relatives of Type 2 Diabetic Patients
    Emilie Blond, PHAR MD
    Hubert Vidal, PHD, Marie Hokayem PHD, Karen Lambert, PHD
    Emmanuelle Meugnier, PHD, Christin Feillet-Coudray, PHD,
    Charles Coudray, PHD, Sandra Pesenti, BS,
    Cedric Luyton, MD, PHD,
    Stéphanie Lambert-Porcheron, MD, PHD,
    Valerie Sauvinet, MS, Christine Fedou, MD, PHD,
    Jean-Frédéric Brun, MD, PHD,
    Jennifer Rieusset, PHD, Catherine Bisbal, PHD,
    Ariane Sultan, MD, PHD, Jacques Mercier, MD, PHD,
    Joelle Goudable, PHD, Anne-Marie Dupuy, MD, PHD,
    Jean-Paul Cristol, MD, PHD, Martine Laville, MD, PHD
    and Antoine Avignon, MD, PHD

    Conclusions: This study demonstrates that resveratrol is a potent
    neuroprotective agent against diabetic oxidative damage.

    4. A Resveratrol and Polyphenol Preparation Suppresses Oxidative
    and Inflammatory Stress Response to a High-Fat, High-Carbohydrate
    Meal

    Husam Ghanim, Chang LingSia, Kelly Korzeniewski, Teekam Lohano
    Sanaa Abuaysheh, Anuritha Marumganti, Ajay Chaudhuri and Paresh Dandona

    Author
    Affiliations

    Division of Endocrinology, Diabetes, and Metabolism, State University of New York at Buffalo, and Kaleida Health, Buffalo, New York 14209

    Conclusions: A
    supplement containing resveratrol and muscadine polyphenols
    suppresses the increase in oxidative stress, lipopolysaccharide and LBP concentrations, and expression of TLR-4, CD14, IL-1β and SOCS-3 in mononuclear cells after an HFHC
    meal. It also stimulates specific Nrf-2 activity and induces the
    expression of the related antioxidant genes, NQO-1 and GST-P1.
    These results demonstrate the acute antioxidant and anti-inflammatory effects of resveratrol and polyphenolic compounds in humans in the postprandial state.

    5. Resveratrol, obesity and diabetes.
    Eur J Pharmacol. 2010 Jun 10;635(1-3):1-8. Epub 2010 Mar 19.
    Szkudelska K, Szkudelski T

    Source
    Department of Animal Physiology and Biochemistry, Poznan
    University of Life Sciences, Poznan, Poland. [email protected]

    Conclusion: The accumulating evidence also indicates the benefits of resveratrol in diabetes and diabetic complications. These data point to the potential possibility of use of
    resveratrol in preventing and/or treating both obesity and diabetes.

    Resveratrol, a natural phytoalexin, normalizes hyperglycemia in
    streptozotocin-nicotinamide induced experimental diabetic rats.

    Biomed Pharmacother. 2008 Nov;62(9):598-605. Epub 2008 Jul 9
    Palsamy P, Subramanian S. Department of Biochemistry, University of Madras, Guindy Campus, Chennai 600 025, Tamilnadu, India.

    Conclusion:
    The antihyperglycemic nature of resveratrol is also
    evidenced from the improvement in the levels of plasma insulin and
    hemoglobin. Further, the results are comparable with glyclazide, an
    oral standard drug. Thus, the present findings suggest that
    resveratrol may be considered as an effective therapeutic agent for
    the treatment of diabetes mellitus.

    6. Attenuation of insulin resistance, metabolic syndrome and
    hepatic oxidative stress by resveratrol in fructose-fed rats.
    Pharmacol Res. 2012 Sep;66(3):260-8. Epub 2012 May 22.
    Bagul PK, Middela H, Matapally S, Padiya R, Bastia T, MadhusudanaK, Reddy BR, Chakravarty S, Banerjee SK.

    Source
    Division of Pharmacology and Chemical Biology, Indian Institute of
    Chemical Technology, Hyderabad 500607, India.

    Conclusions: The present study demonstrates that resveratrol is more effective than metformin alone in improving insulin sensitivity, and attenuating metabolic syndrome and hepatic oxidative stress in
    fructose-fed rats.

    7. Chronic resveratrol administration has beneficial effects in
    experimental model of type 2 diabetic rats.
    Endocr Regul. 2012 Apr;46(2):83-90.
    Soufi FG, Sheervalilou R, Vardiani M, Khalili M, Alipour MR.
    Source
    Department of Physiology, Hormozgan
    University of Medical Sciences, Bandar Abbas. [email protected]

    Conclusion: The results suggest that chronic resveratrol administration is safe and effective, and may be considered as a beneficial therapeutic compound in diabetes.

    In the interest of space I will stop here, however many other well designed investigations support the conclusions set forth in the above studies and trials.

  • StanfordLongevity

    The human clinical trials done at Buscher Univ., Albert Einstein, and the two pharmacy colleges were all undertaken by PhDs in hard medical related sciences. I am a cell biologist and have consulted to these institutions. They are not alternative medicine practitioners as you allege. Furthermore, there is no evidence of either sub acute or acute toxicity from trans-resveratrol administered orally. Not sure where you get this opinion but it it unsupported by the literature. The biokinetic, biochemical, and epigenetic modalities via which Transmax attenuates blood glucose, insulin sensitivity and chronic inflammation, inter alia, are well known and accepted as valid by a consensus of both physicians and research scientists. You have selectively chosen one paragraph from one in vitro study to demean this compound, when the vast body of evidence supports the opposite conclusion.

  • Krusher

    That really is good news with the ever increasing prevalence of diabetes in our country. On a personal level for me, diabetes runs in my daughter-in-law’s family, so a bunch of very nice people and I’m happy they could have a much simpler way to manage their disease. And since my grandchildren are at increased risk for diabetes, this is doubly good news.

    I have to say, though, that Canagliflozin sounds like one of those German words for which there is no English equivalent, like schadenfreude. Or it could be a pastry.

  • docsterx

    Thanks.

    I looked at the link and the articles referenced in the first article. I looked at the editors of the journals cited and the reviewers listed, the authors of the articles and their credentials among other things. Some of the journal editors and reviewers have MDs in Ayurvedic medicine. The whole point of peer review is that similarly credentialed people read the articles to see if the work is valid based on current science. That is, if a paper is submitted on a topic in biochemistry, it is reviewed by people with PhDs in biochemistry. Not by people with no, or limited training in that discipline. This is not the case here. This is somewhat similar to having a naturopath review the research of a pharmacologist.

    The journals that these papers were published in are not mainstream journals. Sometimes, journals such as these, accept papers just to have papers to print. They may be less rigorous than mainstream journals in what they accept. Alternative and complementary medicine journals, while interesting, often do not have hard science behind their findings. Often these publications are not considered reputable.
    I also looked at a few other articles. Even ones published a few years ago (2010) do not seem to cited often, if at all. I would think that if these results were indeed accurate and reproducible, that there would be some favorable mention in a mainstream journal. They don’t seem to be.
    Let me present some information from an abstract from an article from 2012. The article reviewed many other articles concerning resveratrol’s purported beneficial effects on not only diabetes, but on longevity and cancer as well. The authors state:

    “It is widely BELIEVED that calorie restriction (CR) can extend the lifespan
    of MODEL ORGANISMS and protect against aging-related diseases. A
    potential CR mimetic is resveratrol, which MAY HAVE beneficial
    effects against numerous diseases such as type 2 diabetes, cardiovascular diseases, and cancer IN TISSUE CULTURE AND ANIMAL MODELS. HOWEVER, RESVERATROL, IN ITS CURRENT FORM, IS NOT IDEAL AS THERAPY BECAUSE EVEN AT VERY HIGH DOSES IT HAS MODEST EFFICACY AND SIGNIFICANT [negative] DOWNSTREAM EFFECTS.” (Emphasis mine). doi: 10.1016/j.tcb.2012.07.004

    Essentially, what the authors are saying is (based on a review of current scientific literature) that resveratrol may possibly have some positive effects
    on type II diabetes in test systems (not humans) and, with a lot of
    additional study, some benefits for humans may be found. But right
    now not only doesn’t it show beneficial effects against diabetes or
    cancer, but it may indeed BE HARMFUL if taken in sufficient
    quantities. It doesn’t even imply that resveratrol has ANY benefit for the treatment of diabetes or other diseases in humans at this point.

    It doesn’t seem that resveratrol should be used for any of the conditions that the reviewers mentioned, including diabetes, based on their review of current studies.

  • docsterx

    I agree. And your argument holds true for many others: those who need to restrict salt, the obese, those who want to quit smoking and others may well be living with others who don’t want to do those things. But even if you live alone, you may still buy the occasional junk food,
    skip vegetables, etc. Some people who live alone have as much or more
    of a problem with managing diet and losing weight. Some use food for
    comfort for loneliness or stress.

    More restaurants seem to be trying to offer foods that are better for diabetics, overweight people, vegans, etc. than even five years ago. Even fast food restaurants are getting the message. You might want to look at a site like http://eatthis.menshealth.com/home they have some pretty good diet suggestions as to what to eat and where to eat. You can see what restaurants in your area are offering that are sensible choices for people who need to modify their diets.

  • docsterx

    Before you consider a new endocrinologist, at least talk to your current one and see how he feels about an artificial pancreas. And his position on the “if it aint’ broke, don’t fix it” idea. The pancreas is different from a pump in that it’s self-regulating. He may be more positive about the pancreas than the pump. Also, he may want to wait a while to see how it works now that it’s in general release to get a feel for any unexpected problems that might occur that didn’t turn up in clinical trials.
    Also, I checked with the manufacturer. Very few insurances are even considering paying for the pancreas right now. Medicare and Medicaid won’t. Though the manufacturer is working to get as many inscos on board as possible.
    Cost to patient right now is, roughly, $800 for instrument and initial set-up. Then about $400/month for the sensors (each sensor only lasts about 5 days.
    So, it would be expensive if you have to pay out of pocket for it.

    Once inscos come around, cost to patient will drop. Also, apparently other companies are working on their own pancreases. Once these come out, prices may drop to get a larger market share.

  • Thom Allen

    Thanks.

    I looked at a few of the articles, the journals that published them, the credentials of some of the reviewers (in those journals that claim peer review.

    The editors and reviewers of some journals are listed as MDs in in Ayurvedic medicine. The peer review concept is about using peers with similar credentials to review the submitted papers and make sure that the science is sound. Ayurvedic practitioners, if their sole degree is in ayurvedic medicine, do NOT have similar training as some of the PhDs who wrote the articles. So, peer review here can be faulty.

    The articles I looked at were published in journals that are not in the scientific mainstream, for the most part. Alternative and complementary medicine journals and articles, while they may be interesting, are usually not accepted as reputable.

    The articles that I looked at, even ones published a few years ago, were rarely, if ever, cited by more recent articles. That may indicate that they were read by only a few people, were not considered significant, the science was not considered valid or there may have been some other reason that they were not cited.

    Here is an abstract of current research (from 20120 on resveratrol from a peer-reviewed publication:

    It is widely BELIEVED that calorie restriction (CR) can extend the
    lifespan of MODEL ORGANISMS and protect against aging-related diseases. A potential CR mimetic is resveratrol, which MAY HAVE beneficial effects
    against numerous diseases such as type 2 diabetes, cardiovascular
    diseases, and cancer IN TISSUE CULTURE AND ANIMAL MODELS. HOWEVER, RESVERATROL, IN ITS CURRENT FORM, IS NOT IDEAL AS THERAPY BECAUSE EVEN AT VERY HIGH DOSES IT HAS MODEST EFFICACY AND SIGNIFICANT [negative] DOWNSTREAM EFFECTS. (Emphasis mine). doi: 10.1016/j.tcb.2012.07.004

    Essentially, hat that says is (based on a review of current scientific literature) that resveratrol may possibly have some positive effects on type II diabetes in test systems (not humans) and, with a lot of additional study, some benefits for humans may be found. But right now not only doesn’t it show beneficial effects against diabetes or cancer, but it may indeed BE HARMFUL if taken in sufficient quantities.

  • Mark_in_MN

    Yes. But I’m still not sure that’s really a good idea, given the dangers of hypoglycemia. Just my personal assessment of the idea.

  • Mark_in_MN

    Generally I’m in agreement, but I’m not so sure that “not wanting to comply” is quite the right way of putting it. It might be for some, even many, but it also seems to make it all about what someone desires. Loosing weight and even modifying diets can be difficult. I know. They are aspects of my own management of diabetes that I continue to struggle with. It’s not always easy to find low carb meals when away from home. Most restaurants serve shockingly small servings of vegetables, if they include them at all. If it was just myself who had to eat meals at home, it would be somewhat easier. But it isn’t just me and others also need to be accommodated (many dietitians and some physicians seem to think that we each eat by ourselves on our own). And so on.

  • Cletus

    Everything within reason. I meant a blocker that would reduce the amount of glucose uptake – not something that would totally prevent it.

  • Mark_in_MN

    It’ just not that simple, Nicho. There are people with all the risk factors against them, including diet, that don’t develop diabetes, and people who would theoretically have lower risks who do. And it’s not just sugars involved, one has to throw in complex carbohydrates, fats, activity and exercise, possibly eating patterns (not just what is eaten), probably genetics and other factors too.

    There is most certainly plenty of reasons to be highly critical of the food and pharmaceutical industries. But there are aspects of culture that need to be considered, too. Note that fewer of us cook from scratch, while once that was just about the only way to be able to eat. Does that contribute? The food industry has pushed that, but it also responded to it. But even those who do mostly cook from scratch themselves, aren’t immune to developing diabetes, as in my case. It’s just not a simple puzzle in the least.

    “Big Pharma” certainly has a rapacious streak. I’m not a fan of how the companies operate at all. On the other hand, they do make the drugs that keep me alive and relatively healthy. I’m grateful we have them, and the other medical technology that they an others have developed, and on which I and so many people rely.

  • Mark_in_MN

    I’m not sure such a blocker would be a good idea. We all need glucose as a basic energy driver. Blocking its uptake could lead to very serious issues, even for the diabetic. How would one deal with (probably likely) instances of hypoglycemia if there is substantial blockage of glucose uptake in the digestive track?

    What’s really needed is a drug that directly effects the mechanism that makes a type II diabetic insulin resistant. But the disease is complex enough, that a one mechanism “fix” probably wouldn’t actually address the whole. From my understanding, there are still mysteries about the disease that mean we manage it rather than directly correct it.

  • Mike_in_the_Tundra

    Perhaps I need to look around for a new endocrinologist, but that will be a difficult decisions. He was very much against a pump when I asked. It’s just a tough decision. I’m very aware of the fluctuations of blood sugar levels. Anyone who has ever had a low blood sugar event is very aware of the fluctuations. I scared the hell out of my husband a couple of times, because I get really stupid and couldn’t properly communicate the problem to him. He learned to recognize the problem.

  • Mike_in_the_Tundra

    We may have had different motivations for being vegan, but I do agree that it seems to work great for diabetics. I believe it is possible for non-vegans to affect their sugar levels with diet. I don’t see how diets can totally help Type 1s entirely, but it can make it easier. I still feel that it comes out to to calories in and calories out.

  • StanfordLongevity

    See below:

    http://www.nutraingredients-usa.com/content/search?SearchText=resveratrol+diabetes

    If you search on scholar.google.com for “diabetes resveratrol” you will see many others.

  • FauxReal

    I was diagnosed around the same time as you but my numbers were never high – just slightly above what is considered normal. I’ve controlled it since with diet and exercise. I’m not vegan but I do low fat and low carb and my numbers have been in the normal range since I was diagnosed. In a strange way, getting the diagnosis was good for me in that I eat healthier and actually do some exercise. It really hasn’t been that difficult. If I get an urge for something I do a tradeoff with something else.

  • docsterx

    Your references, please?

  • docsterx

    The first thing is to explain to the patient what diabetes is, how to treat it, what associated problems it can lead to, etc. Then talk to them about diet, weight loss and exercise. Some patients, if they do lose weight and watch their diets, may not need medications, at all. If that doesn’t work there are algorithms developed from research studies by groups like the American Diabetes Association that suggest which drug(s) to use and when. Most patients get started on metformin and then, after some time, see how they’re doing. If not responding well, any of a number of other drugs can be added, stepwise to try to get glucose under control. So there’s science, involved, plus some trial-and-error (dosage adjustments, exercise regimes, nutrition consultations) for each individual patients. And maybe a little skill and using the art of medicine, too.

    Exenatide is used as an additional drug to supplement metformin or a sulfonylurea. Drawbacks can be the fact that is needs to be injected and cost for some patients. Some patients would rather cuddle a gila monster than take a shot.

  • StanfordLongevity

    There are safer and more effective alternatives to drugs to treat Type 2 Diabetes. One, that can also be used with drugs such as Metformin, is Resveratrol. In two recently published human clinical trials done by respected medical schools it was shown that transmax resveratrol in the first study, and bioforte resveratrol in the second one, had the effect of reducing blood glucose, improving insulin sensitivity, lowering blood pressure and LDL cholesterol, and even lowering body weight. The scientist who did the transmax study stated, “Resveratrol can be an effective adjunct therapy for type 2 Diabetics currently using one of the Metformin like drugs, or who are controlling their Diabetes without drugs.

  • Whitewitch

    He has totally changed his diet, lost weight and starting walking (5 to 7 miles a day) and is off injectable insulin, though still on two oral meds…it is hard to loose weight when you are locked into the insulin medication cycle. This might be a nice change for him.

  • docsterx

    Thanks for the kind words.

  • docsterx

    “I asked my doctor why he had not recommended this approach and he said most people would not do it.”

    You’re doctor is right. Some people will try, for a time, to modify eating habits to lose weight, and they may try an exercise program, often briefly. But it’s fairly rare for anyone to stick with it and lose weight, watch diet and exercise regularly. It’s much easier to continue to eat and drink what we want, not exercise and take a pill that “fixes” the problem. That applies for many patients, not just diabetics. It’s not about “pill pimping” at all. It’s about millions of people not wanting to comply with things like weight control and diet modifications.

  • docsterx

    The “don’t fix it if it ain’t broke” adage really doesn’t apply to diabetes. We haven’t fixed it at all. we’ve just modified it somewhat.

    In non-diabetics the endocrine, CNS, liver, gut, kidney and other systems all play a role in maintaining the blood glucose in a fairly tight range. Adjustments are made as needed practically on a minute-by-minute basis.

    With one a day or two a day anti-diabetic medications, or insulin, there can sometimes be periods when the blood glucose is abnormal – high or low – and the patient may not be aware of it. That’s a far cry from the body regulating glucose levels much more quickly in non-diabetics. The artificial pancreas works more like the body’s usual physiology. Adding insulin when needed to prevent both major swings in glucose or prolonged periods of mildly elevated glucose. So, what we’re doing by current, conventional methods doesn’t come anywhere near to making diabetes “fixed.”

    BTW, I have no financial interest in the artificial pancreas or any anti-diabetic medications. I just think that this development of the artificial pancreas is an incredible benefit for diabetics who rely on insulin.

  • will

    Actually it’s more about the fat. insulin is like a key to open cells and allow the glucose to enter. Our fatty fat fat western-diets stop responding to insulin.

  • Tony Perreault

    I’ve been taking Invokana since August. I could not tolerate the 300mg dose, but cutting the pills in half has been working great. Before I would have a blood sugar crash about once a week, with my levels dropping down to low 60s / upper 50s. On Invokana this hasn’t happened at all. Plus I’m dropping about a little over a pound a week. When I started in August I was 257 lbs, now I’m down to around 230 lbs without doing anything out of the ordinary (no change in diet, no additional exercise).

  • Will

    I was type 2 diagnosed diabetic in 2007 after having vision issues. I was told that I needed to be on insulin right away, my A1C was above 10 and my first glucose blood test was 450. I read a book about controlling diabetes through a low fat, low glycemic vegan diet. I am now around 6.5 A1C without taking insulin or any other diabetes drugs.

    I asked my doctor why he had not recommended this approach and he said most people would not do it. And that is the problem with health care in this country. We don’t have health care, we have pill pimps running the show.

  • Whitewitch

    This sounds wonderful…as the spouse of a Type II Diabetic it will be nice when it is available…side effects sounds great – especially weight loss and getting off the multiple meds currently on! Thanks for sharing this great news.

  • http://www.americablog.com/ Naja pallida

    I’m curious, as a non-doctor, and non-diabetic, how does one come to the decision of whether to use a SGLT2 inhibitor, a GLP-1 agonist, an alpha-glucosidase inhibitor, a TZD, etc… it seems like there are so many options out there now for potential treatments for type 2 diabetes. How do you come to the conclusion that one course of treatment is going to be more effective over another? Is it trial and error? I get that you have to look at the whole picture of a person’s current health profile, lifestyle and such, which could rule out many options quickly, but it just seems like there are more and more choices on the market. Not to mention, there are at least a half dozen other SGLT2 inhibitors, one from every major pharmaceutical company, what makes this one superior to the others?

    I have a particular interest in the GLP-1 agonist exenatide, because it was derived from a hormone found in the venom of the gila monster. :)

  • Mike_in_the_Tundra

    I don’t think measuring urine glucose is used much anymore. It does sound like your idea would also help with weight loss.

  • Mike_in_the_Tundra

    I’m not certain that too much sugar can give one diabetes. I could not have consumed all that much sugar by the time I was eleven. I do think that being overweight does make one more vulnerable to Type 2.

  • Mike_in_the_Tundra

    I’ve read about it in “Diabetes Forecast.” I would be willing to give it a try, but my doctor will say one doesn’t fix what’s not broken. That’s what I was told about an insulin pump. There’s something to that.

  • nicho

    So Big Agribusiness poisons the food supply with massive amounts of sugar that give you diabetes, making billions of dollars, and then Big Pharma sells you a pill to control it. Is capitalism great or what?

  • Cletus

    Interesting, because traditionally one of the ways of monitoring diabetic health is urine glucose content, so this would skew those results. What’s really needed is a channel blocker that prohibits the glucose from being taken up in the blood in the first place.

  • docsterx

    Mike,
    Just FYI, the FDA recently approved the first artificial pancreas for use in the US. It clips on to the pants and continuously senses glucose levels and automatically delivers insulin as needed. Might be something you’d be interested in.

  • Mike_in_the_Tundra

    I’m always happy to see any progress made for this disease. It doesn’t matter if it’s Type 1 or Type 2. I’ve been battling this disease for over four decades. I’m closing in on five decades at an alarming rate. The changes since I was diagnosed are wonderful, almost miraculous.

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