What does the Gila monster have to do with Diabetes?
There are many very exciting advances in medications and certainly a lot of research and funding is currently going into making diabetes a better managed chronic disease that is patient friendly and addresses many of the problems that diabetics face.
One of the very exciting newer medications recently available is a medication called an "incretin mimetic". The science linked to the way this medicine works is simply fascinating and one of those moments where physiology (the science of the basic functioning of the body at cellular level) and pharmacology (the science of how medicines work at cellular level in the body) make complete sense.
In the 1970's physiologists (the scientist who research physiology) discovered the "incretin effect" which means, very simply, that if you eat sugar by ingesting it orally (the normal way) vs. if you have the same amount of sugar by intravenous injection (by a drip into your vein) the sugar is processed in a different way and a certain hormone called an incretin is ONLY released if you ingest sugar orally (released by gut cells – cells in your stomach/tummy). What this means is that the incretin mimetic increases the amount of insulin secreted by the pancreas and this only happens via the oral route and not the intravenous route.
A few different things happen when the incretin effect kicks in: more glucose-dependant insulin secretion, less secretion of a hormone that antagonises (goes against) the effect of insulin, slowing of the stomach emptying effect and consequent reduced intake of food.
And this is the reason we are so excited! The incretin medications are the first on the market to actually help with weight loss. Many type 2 diabetics are overweight and the problem is that the excess weight further damages the pancreas indirectly and also interferes with control of diabetes. A medication that both helps with weight loss as well as controls sugar is something we have been waiting for (both doctors and patients).
The other exciting breakthrough with this medication is that it helps to protect pancreas cells (these are the cells that are damaged and progressively so in diabetes). This is the first time we have a little hope of actually halting "cell death" or apoptosis. What this means is that (although not proven by trials yet) there is hope that the progressive nature of type 2 diabetes may possibly be curbed.
Although the physiologists found the incretins way back then the effect could not be utilised until recently due to the fact that in the body this molecule is broken down almost as soon as it is produced – which means you could not use it as a medication.
Enter the Gila monster! The Gila monster is a reptile that apparently only eats once a year and in its saliva it has incretin mimetics that are stable for much longer than they are in humans. Once the scientists had isolated (from the Gila monster's saliva) exenedine it was a matter of time before they could make this molecule in the laboratory (using the similar chemical structure) so that it could be produced to utilise this unique effect as a medication that was safe for humans to use.
This is all very new and still in the early phases of being used for treatment and it would be prudent to keep an eye on on-going medical studies, nevertheless a step in the direction of better understanding of diabetes and management thereof. Unfortunately all new medications (due to the extensive research) come at a higher cost and this is a limiting factor in the use of the incretins.
What we do have that is free to all is: exercise and healthy choices in eating. (Well at least free in that it does not incur an extra cost over and above that of everyday living).
Type 2 diabetes is a growing problem and managing it remains a team effort involving a willing patient and a team of supporting medical practitioners. Despite its challenges there is hope and new impetus to see advances in this field. There are answers to some of our questions (both patients and doctor's questions) and the exciting news is that currently in the field of diabetes this is exploding in all kinds of directions bringing us solutions.
Written by Dr Claudine Lee 26 Hilton Avenue 033 343 2243 – recently moved to Hilton and happy to be of service to all patients needing a family doctor, help with diabetes, insulin pump therapy, small surgeries, pap smears and antenatal care, holistic and preventative medicine and eye conditions.