Understanding Once-Weekly GLP-1 Agonists for Type 2 Diabetes

Once-Weekly GLP-1 Agonists for Type 2 Diabetes

 

With all of the modern-day scientific and technological advances for the treatment of diabetes, pharmaceutical industries have developed easy to use, with less frequent injecting medications to help achieve the optimal blood glucose (sugar) levels. There is a hormone in your gut that helps control blood sugars after you eat.  If you have diabetes, that hormone is deficient or not working properly. This hormone is the glucagon-like peptide 1, more commonly referred to as GLP-1. Medications have been developed to replace this hormone.  It is often added to your medication regimen either second or third after metformin which is the drug of choice for type 2 diabetes. These medications are available as twice a day, once a day and once a week injectable agents.  This blog will describe the medications available once a week.

These medications have a low risk of low blood sugar reactions (hypoglycemia) and do not cause weight gain.  They actually may help with weight loss. Nausea is a common side effect, but usually goes away with time.  Some patients may have vomiting, but it is less common.  Because these medications make you feel full, eating less may help decrease the nausea as well as help weight loss.

There are three agents available that can be injected once a week, they are Trulicity® (dulaglutide), Bydureon®(exenatide) and Tanzeum® (albiglutide).

The Trulicity® pen comes in two doses;your healthcare provider will make the decision as to which pen’s dosage is best for you.There are 3 simple steps to administering the Trulicity® pen. First make sure the pen is locked, uncap the pen by pulling the base cap straight off. Once the pen is locked, place the clear base flat and firmly against your skin at the injection site, and then unlock the pen by turning the lock ring. Finally, you then press and hold the green injection button, which will make a loud click sound. At this point, the clear base must be held firmly until you hear a second click, holding for about 5-10 seconds, then remove the pen. The needle is contained in the pen and you don’t have to attach it.  The manufacturer recommends disposing of the device in a sharps container.  The needle is never exposed with this pen.

The Bydureon device is a single use, dual-chambered pen that comes pre-filled. The pen involves a “twist, tap, twist” preparation process. To use Bydureon you first attach the needle to the device, twist the base of the pen (stopping at the sound of the first click), which will combine the medicine, then tap the pen firmly against the palm of your hand (up to 80 times or more) to mix the medication, twist the base of the pen once more until the injection button is released, then finally remove the needle cover and inject at an appropriate injection site. Some patients develop bumps (nodules) where they inject.  They don’t hurt and go away over time. Dispose of the device and needle in a sharps container.

The Tanzeum® pen comes in 2 doses which also requires mixing in the pen by twisting the clear cartridge on the pen in the direction of the arrow until you hear a “click”. The pen must be gently and slowly rocked side-to-side 5 times in order for the solution to be properly mixed. To avoid foaming, make sure the pen is not shaken too hard. Once the solution is mixed, wait 15 minutes for the lower does and30 minutes for the higher dose before injection to ensure the reconstituted solution is mixed. Your provider may show you an alternative mixing strategy where you don’t wait as long and make sure the medication is mixed, if appropriate. You may inject the pen into an appropriate site once all the necessary steps are taken to mix the solution. Dispose of the pen and needle in a sharps container.

GLP-1 RA medications are to be used along with proper diet and exercise in patients with type 2 diabetes. They are usually added on to metformin.  Injecting once a week can be an attractive option for patients.

Consult your healthcare provider to determine if you are a good candidate for one of the three, once-weekly GLP-1 RA medications, to reduce blood sugars and A1C.

 

This Article is Brought to you By Our Guest Staff Writers:
Bilal Aslam Pharm.D. Candidate 2017 MCPHS University
Jennifer Goldman, RPh, PharmD, CDE, BC-ADM Professor of Pharmacy Practice, MCPHS University, Boston, MA
Clinical Pharmacist, Well Life, Peabody, MA

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