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Diabetes Medication

Our Double Bind

Most people with diabetes need to take oral medication or insulin to control it. Only 15 percent of us don’t take either insulin or oral medication, and its likely that few of this 15 percent have their diabetes under control.

But almost all of those drugs make us gain weight. This weight gain makes it harder to control diabetes. That’s a double bind.

Until a few years ago when metformin became available, every diabetes medication caused us to gain weight. That’s one reason why metformin quickly became the biggest selling diabetes drug.

Bristol-Myers Squibb, which sells the Glucophage brand of metformin, has documented the typical weight loss of a few pounds when people take it. This is in its “Full Prescribing Information” , which the Food and Drug Administration clears.

When my endocrinologist first suggested that I use metformin, he said that I might lose weight because I would be less hungry. He also warned me to increase my dose gradually so that I could avoid what is delicately called “gastrointestinal distress.”

Personally, I didn’t experience either less hunger or gastrointestinal distress. But those are the reasons generally cited to explain why metformin usually leads to weight loss.

Metformin is still the only oral medication that typically won’t cause you to gain weight. But in the past few months we now have two exciting options that, like insulin, people take by injection.

For years I have been excited about Byetta, which the FDA finally approved in April 2005. 
This is the famous “monster drug” based on Gila monster venom that I first wrote about in 2002 when they still called it exendin-4.

Amylin Pharmaceuticals and Lilly distribute Byetta. They document a typical weight loss of several pounds for people using it.

In March 2005 the FDA approved another new drug from Amylin Pharmaceuticals called Symlin. This drug also has documented weight loss.

Now we can also look forward to an insulin that won’t cause much if any weight gain – although not weight loss. In June 2005 the FDA approved Levemir, a long-acting insulin that is poised to rival the phenomenally successful Lantus.

The manufacturer, Novo Nordisk, has made a couple of statements about Levemir and weight. The company’s Full Prescribing Information doesn’t compare it with Lantus, saying only that “Levemir was associated with somewhat less weight gain than NPH” insulin, which stands for neutral protamine Hagedorn and is intermediate acting.

Novo Nordisk also issued a press release on Levemir when the FDA approved it. It says that Levemir “has been shown to cause little weight change.”

We have been waiting for Levemir for a long time. I first wrote about it in an article for Diabetes Wellness Letter (now called Diabetes Wellness News) in 1998 when Novo Nordisk still called it NN304.

We can’t buy Levemir yet. But Novo Nordisk says that they will launch Levemir in 2006.

It’s beginning to look like the constriction of our double bind is beginning to loosen.

This article is based on an earlier version of my article published by HealthCentral.

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