Gila Spit to Diabetes treatment

earlier 20222022

Jun 13

In 1964 researchers discovered something interesting about glucose and its effects upon insulin. Giving glucose by mouth would cause a large and rapid increase in plasma insulin levels. Giving the exact same amount parentally would result in lower levels. The difference was about 65% and it would become known as the “incretin effect”. The hormones behind this effect would eventually be discovered glucagon-like peptide (GLP1) and gastric inhibitory protein (GIP). These hormones are produced when you eat and stimulate your pancreas to produce more insulin, GLP1 also slows down gastric emptying and peristalsis which results in you feeling full and not eating that fourth/fifth cupcake. These hormones do not hang around long because they are quickly metabolized by a small glycoprotein called dipeptidyl peptidase 4 (DPP4). DPP4 is widely expressed and found on the surface of nearly every cell so it makes quick work shredding up GIP/GLP1 giving you that second wind for the sixth cupcake.

These hormones would become obvious therapeutic targets for reducing blood sugar. The race was on to find something that could replicate the marvelous effects and the first candidate would come from the most unlikely of places: the saliva of a Gila monster. The drug discovered is now known as Byetta (exenatide) and it has been used successfully in millions of patients. Exenatide does many of the same things that GLP1 does with one key difference: it could hang around for hours as opposed to minutes. The only downside was the drug was not well absorbed orally and must be given as an injection. Recent developments in nanoparticle technology may have solved the absorption issue so an oral form of the drug may be on the horizon. Similar products would soon follow, Victoza, Bydureon, Trulicity, and Ozempic are all GLP1 receptor agonists.

GLP1 receptor agonists are NOT insulin which is a common misconception since they are an injectable medication for diabetes. They are also not approved for weight loss although many patients lose weight taking them Ozempic in particular. The newest drug to enter this class is called Mounjaro (tirzepatide) from Eli Lilly and it is getting all the attention because it is the first drug to act on both GLP1 and GIP receptors. While it is approved for diabetes the average weight loss for patients receiving the drug was between 12 and 25 pounds! When you add DPP4 inhibitors like Januvia and traditional drugs like metformin into the mix we pretty much have diabetes surrounded from a biochemistry perspective.

The cure for obesity is no mystery but exercise and self-control are tough to accomplish and difficult to monetize. Drugs however are easy to take and incredibly commercially viable, the price tag for this new medicine is about a thousand dollars a month. They could probably charge more if it lives up to the hype especially if they were to pursue an actual approval for weight loss. This drug could be a golden goose for Eli Lilly. An effective weight loss product with minimal side effects is like stumbling onto the holy grail for a drug company. If it ever gets that far I am curious if it will be mandated, after all the costs to society from obesity are astronomical.

Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts

hyattjn@gmail.com

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Gila Spit to Diabetes treatment

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