Pramlintide in the Treatment of Diabetes Mellitus

Pramlintide is a synthetic amylin designed to be used in conjunction with insulin for patients who fail to control their glycemic levels with insulin alone [1]. Pramlintide is similar in its structure and function to islet amyloid polypeptide (IAPP), which is a hormone secreted along with insulin by Beta cells located within the pancreas [2]. The role of this hormone is to aid in controlling postprandial hyperglycemia, by suppressing glucagon secretion, reducing the rate of gastric emptying, and regulating food intake by sending satiety signals to the brain.

Pramlintide is administered through subcutaneous injection prior to major meals. Depending on the diabetic diagnosis, dosages may vary. For patients with type 2 diabetes, the dose starts at 60 mcg and can be increased up to 120 mcg if no significant nausea is experienced; while patients with type 1 diabetes start at 15 mcg and can be increased up to 60 mcg. Pramlintide is seen to be effective by its high affinity for receptor activity modifying proteins (RAMP) receptors and is absorbed at a rate of 30%-40%. It is metabolized by the liver and excreted through urine[3]. Similar to insulin Pramlintide should be stored in the refrigerator to avoid temperature extremes[3].

Polypharmacy with Pramlintide is common but interactions with certain drugs can be detrimental. Incidentally, when taken with insulin it can increase the likelihood of hypoglycemia. Taking drugs such as atropine or anticholinergics may slow down gastric motility whereas, acarbose and miglitol may reduce the rate at which nutrients are absorbed[4]. These drugs should be taken with careful physician monitoring.

Physical therapist should be aware of adverse effects associated with Pramlintide. While exercising, the therapist should watch the patient for symptoms of hypoglycemia including anxiety, tingling and numbness in the arms and legs, chills, sweats, and unsteady gait [5]. The major adverse effect of Pramlintide is hypoglycemia because it is taken concurrently with insulin [6]. Other minor common adverse effects include nausea, abdominal pain,vomiting, and irritation around the injection site[4]. During treatment avoid applying physical agents or massage around the injection site because it can change the drug absorption from subcutaneous tissues. Physical therapist should also encourage patients to eat a healthy diet and monitor blood glucose before and after exercise. Aerobic exercises will help improve insulin sensitivity, increase blood flow to extremities, and maintain a healthy weight[7].

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References

  1. Łoboda, D., & Rowińska-Żyrek, M. (2017). Zn(II) - pramlintide: Stability, binding sites and unexpected aggregation. Journal of Inorganic Biochemistry,174, 150-155. doi:10.1016/j.jinorgbio.2017.06.008
  2. Hinshaw L, Schiavon M, Dadlani V, et al. Effect of Pramlintide on Postprandial Glucose Fluxes in Type 1 Diabetes. J Clin Endocrinol Metab. 2016;101(5):1954-62.
  3. 3.0 3.1 LP, A. P. (2015, February). SYMLIN (pramlintide acetate). Retrieved from FDA: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/021332s025lbl.pdf
  4. 4.0 4.1 Ciccone, C. D. (2013). Davis's Drug Guide for Rehabilitation Professionals. Philidelphia: F.A. Davis Company .
  5. Triplitt CL, Reasner CA. Diabetes mellitus, In: DiPiro JT, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011.
  6. Ryan, G. J., Jobe, L. J., & Martin, R. (2005). Pramlintide in the treatment of type 1 and type 2 diabetes mellitus. Clinical Therapeutics,27(10), 1500-1512. doi:10.1016/j.clinthera.2005.10.009
  7. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147-67.