therapeutic options available for the treatment of type 1 diabetes
- Patients with type 1 diabetes have deficiency of both insulin and amylin. Without insulin these patients develop hyperglycemia and ketosis (i.e., diabetic ketoacidosis).
- These patients typically require long-acting insulin (glargine, detemir, neutral protamine Hagedorn [NPH]) to cover basal needs and short acting insulin (i.e., lispro, aspart, glulisine, regular) to cover meals.
- Insulin can also be delivered via a pump devise in select patients. The predominant side effect is hypoglycemia.
- Amylin analogues (i.e., pramlintide) can also be prescribed in type 1 diabetes to suppress glucagon mediated hepatic glucose production, improve satiety, and slow gastric emptying.
- Amylin injections are given in addition to insulin.
- Modest weight loss and improvements in hemoglobin A1c (< 1%) are noted with treatment.
- Risk of hypoglycemia and the inconvenience of multiple daily injections limit the use of amylin.
