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New Treatments (and Old Advice) Can Aid Diabetics

Insulin that's inhaled through the mouth. A drug derived from lizard saliva that could promote weight loss. These are among the treatment advances that hold great promise for the 21 million Americans with diabetes. Coupled with a more familiar doctor's order — exercise! — the treatments could help more people avoid the disease's disabling and life-shortening complications.

The new type of insulin is expected to become available to the public this month. Instead of injecting the drug, diabetics will inhale a powdered form through the mouth. Dr. Martin Abrahamson, chief doctor at the Joslin Diabetes Center in Boston, is excited about the innovation. "For some people, this is going to represent the removal of yet another barrier toward improving their glucose control." (Scroll down to read recommendations about appropriate candidates for the inhalable insulin.)

Glucose control — keeping blood sugar as close to normal as possible — is vital for diabetics. Patients must prick their fingers several times a day to monitor blood-sugar levels. They must also watch their diet, exercise and take pills. And most of them ultimately must use insulin, which is typically taken by injection. Inhalable insulin "might even spare [some people] the use of injections," Abrahamson says.

That is, if they can afford it, or if their health plan will pay. Inhalable insulin is expected to cost 30 percent more than injectable insulin.

The new form of insulin isn't the only forward step in diabetes care. More and more patients with Type 2 diabetes, the most common kind, are using an injected drug called exenatide — brand name, Byetta. It's the first new type of diabetes drug in years. It stimulates natural insulin release in a different way from older drugs. Exenatide is a long-acting version of a natural hormone released in the stomach. The hormone basically primes the insulin pump: It tells the pancreas to start releasing insulin as soon as food enters the stomach. Oddly enough, exenatide is derived from the saliva of a big lizard called a Gila monster.

Exenatide also comes with a very attractive bonus.

"One of the side effects," says Abrahamson, "is weight loss." Studies show patients lose 10 to 12 pounds on average in the first year or two of using the drug. That's apparently because it makes people feel full after eating less.

One of Abrahamson's patients, Barry Kittredge, has already shed 18 pounds since he began taking exenatide in April.

"I don't eat anywhere near what I used to," says Kittredge. "I eat so much and I just say, 'That's enough.' And I never said that before." He's currently dropped to 232 pounds and is aiming for 225. That's when his adult son, Tim, has promised to buy dad a new wardrobe.

Taking the new drug has also dropped Kittredge's cumulative blood-sugar readings — using a test called hemoglobin A-1c — into the normal range. That's pretty important for a man whose diabetes has already cost him the sight of one eye, not to mention the amputation of seven toes and serious circulation problems.

Currently, exenatide must be injected, but companies are working on new versions that don't need to be injected. Someday there may be a once-a-week form of the drug.

But it'd be a big mistake to think new drugs are all that diabetes patients need.

After years of taking pills, injecting insulin and suffering complications anyway, Barry Kittredge has "got religion," as his doctor puts it. He now believes in pills and diet ... and exercise. Jacquie Sahar, his exercise specialist at Joslin, explains that an increase in muscle mass means a metabolism that burns calories more effectively — and that burns glucose as well. And that's really the goal. After coaching Kittredge through his routine, Shahar checks his blood sugar to compare it with the reading before his workout.

"Wow, this is great," she tells him. "This is wonderful to see how exercise can affect your blood sugar. It dropped more than 40 points." That kind of instant feedback is a great motivator, she says. A daily workout could mean that a patient like Kittredge might be able to cut back on the drugs he takes for his diabetes. So old-fashioned exercise is still one of the best treatment plans around.

Copyright 2023 NPR. To see more, visit https://www.npr.org.

Corrected: September 13, 2006 at 9:00 PM PDT
The broadcast and Web version of this story originally stated that a new form of insulin could be inhaled by nasal spray. In fact, patients inhale a powdered form of insulin through the mouth.
Since he joined NPR in 2000, Knox has covered a broad range of issues and events in public health, medicine, and science. His reports can be heard on NPR's Morning Edition, All Things Considered, Weekend Edition, Talk of the Nation, and newscasts.