Diabetes Health Center

Non-Insulin Diabetes Injectables

When insulin was first discovered in 1921, it's not an overstatement to say that it revolutionized the treatment of diabetes. No longer was diabetes considered a death sentence. For the first time, people with diabetes could expect to live longer, fuller lives.

Insulin transformed diabetes treatment, but for many decades it was the only drug available to treat diabetes. Then came another mini-revolution with the introduction of the first oral, non-insulin drugs to treat type 2 diabetes, including metformin and the sulfonylurea class of drugs.

Today, metformin is the first drug doctors usually recommend for people with type 2 diabetes who need to take medication. Researchers have still been on the hunt for other diabetes treatment options because metformin doesn't work for everyone who has diabetes. Some people who take this drug still have trouble controlling their blood sugar and A1C number.

In recent years, new drugs have been introduced that offer more options for people with type 1 and type 2 diabetes. In 2005, the U.S. Food and Drug Administration approved two injectable non-insulin medications -- pramlintide (Symlin) and exenatide (Byetta). Then in 2010, the FDA also approved the drug liraglutide (Victoza).

Unlike insulin, which lowers blood sugar by pulling glucose from the bloodstream into cells, these drugs cause the body to release insulin, or work with insulin to control blood sugar levels.

Here's a rundown of the three non-insulin injections your doctor might recommend for controlling your blood sugar levels -- how they work, who they help, and what side effects they can have.

Pramlintide (Symlin)

What it is: Symlin is a man-made version of a hormone called amylin, which is produced along with insulin by the pancreas when blood glucose levels rise.

Who can take it: Symlin is designed for people who aren't able to get their A1C number down to the recommended less than 7.0% using other medications. It's approved for people with type 1 diabetes who are taking insulin, and people with type 2 diabetes who are taking insulin, a sulfonylurea drug, and/or metformin.

What it does: You take Symlin with insulin after a meal. The two drugs work together to lower your blood sugar. Symlin also slows your body's digestion of food, which puts less sugar into your bloodstream. In addition to controlling your A1C levels, Symlin helps reduce your appetite, so you eat less.

Side effects: The most common side effects of Symlin are nausea, stomach pain, diarrhea, and vomiting. Starting this drug at a low dose and increasing it slowly can help combat the nausea. Symlin can also cause a drop in blood sugar (hypoglycemia) if you don't adjust the amount of insulin you're taking.

Exenatide (Byetta)

What it is: This diabetes drug’s discovery comes from an unlikely source -- the saliva of the Gila monster, a huge desert-dwelling lizard. Byetta is actually a man-made version of a hormone called glucagon-like peptide-1 (GLP-1), which is found in Gila monster spit. Your intestines normally release this hormone when you eat.