WPADE.org

By Annette R. Karnash, R.N., M.N.

New medications called incretin mimetic are currently undergoing clinical trials and may have significant potential impact for a new more effective treatment of diabetes. Incretin minetics are endogenous hormones secreted from the G.I. tract. When food is ingested the G.I. tract secretes an endogenous hormone incretin, which stimulates the secretion of insulin in response to glucose absorption. Two of these hormones, glucose dependent insulinotropic peptide and glucagons – like peptide -1 (GLP-1) have been identified. Aside from increased insulin levels, GLP-1 is thought to also suppress the production of glucagons.

Exenatide is the first incretin mimetic to undergo phase 3 clinical trials. Three studies, 30 weeks long, resulted in a significant reduction in A1C in the patients unable to obtain adequate blood sugar levels with metformin alone or with the addition of a sulfonylurea. The result – the average reduction in A1C over placebo was 1% and improvement in pancreatic beta cell function, while the most common adverse effect was nausea and weight loss. A disadvantage is that the drug is administered only by injection but development is underway to produce a long acting form. Incretin mimetics may likely be an important new therapy category to improve diabetic outcome.

By Annette R. Karnash, R.N., M.N.

Sleep disturbances and an elevated resting heart rate in middle aged men may be associated with an increase risk of diabetes. A Swedish study looked at 6,599 initially healthy non diabetic men. In 15 years there were 615 subjects that had difficulty with insomnia or used hypnotic on a regular basis and 158 subjects had both. In the 15 year follow-up, 281 subject developed diabetes. Difficulties with insomnia or the regular use of hypnotic and an elevated resting heart rate was determined to be associated with the development of diabetes.

By Annette R. Karnash, R.N., M.N.

To prevent kidney disease and control hypertension, many patients with diabetes have been prescribed angiotension-converting enzyme inhibitors (ACE) which can cause coughing due to the increased nitric oxide in the lungs. Researchers have concluded that iron supplements may successfully decrease the ACE inhibitor – induced cough by producing less nitric acid.
(Samsung Medical Center, Seoul, South Korea)

By Annette R. Karnash, R.N., M.N.

Patients with diabetes do not examine their feet as routinely as they should and consequently develop foot ulcers, infections and ultimately amputation results. On examining the feet of a patient with diabetes, aside from sensory testing, one should observe for ulcers primarily on the base of the toes and balls of the feet. Observe also for muscular atrophy, which is often associated with nerve damage (neuropathy), resulting in loss of protective sensation and poor motor functioning, leaving the patient vulnerable to injury and deformities of the toes and feet.

By Annette R. Karnash, R.N., M.N.

A study in the United Kingdom (database) found that the longer patients with type 2 diabetes receive insulin, the higher the risk of colorectal cancer. Those receiving insulin for over 5 years had 4 times the risk compared with the non-insulin group.
(Gastroenterology, Oct. 2004)

Patients with diabetes have 2-4 times the risk of liver cancer and over 2 times the risk of pancreatic cancer, compared with non-diabetes patients. However, no increased risk for any other type was noted.