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Question:

From Moorhead, Minnesota, USA:

My husband is 23 and has had type 1 diabetes for many years. I recently heard about how type 1 patients are also missing another hormone and there are research studies where they are giving it to patients and the patients are responding with better mood and much more energy. I do not know the name of the hormone or any other specifics but would be very interested to know if anyone has more information on this. My husband is very tired a lot.

Answer:

You probably heard about amylin (or Amyloid Polypeptide) which is a newly discovered hormone that is co-secreted along with insulin by pancreatic beta cells in response to a rise in blood sugar. Therefore it is deficient (like insulin) in Type 1 diabetic patients, like your husband, at the same time as that of insulin with the progressive immunological destruction of the beta cells.

Its primary metabolic effects seems to inhibit gastric emptying thus regulating glucose absorption from the gut to match the rate at which it is disposed of in the rest of the body and to conserve liver glycogen at the expense of muscle glycogen. Amylin Pharmaceuticals, Inc. (www.amylin.com) have made a synthetic analogue of human amylin under the name of pramlintide and studies in Type 1 as well as Type 2 patients are under way. From first data, it seems to slightly improve metabolic control as well as weight and cholesterol profiles without increasing the risk of hypoglycemia. Whether this new and expensive drug (compared with the cheaper acarbose which has a very similar mechanism of action and is a non-invasive drug) will make a real cost-effective contribution to long term metabolic control remains to be seen.

Your husband's symptoms could more probably relate to some degree of thyroid insufficiency due to autoimmune thyroid disease and can be easily diagnosed by checking thyroid hormone levels in the blood.

MS

Additional comments from Dr. O'Brien:

Amylin has sometimes been described as "the third islet cell hormone." It controls blood sugar by decreasing gastric absorption and by diminishing the release of glucose from the liver. It has mostly been used with Type 2 Diabetes. An analogue called pramlintide has been made by Amylin Pharmaceuticals in San Diego. There is some doubt though whether its limited usefulness justifies the cost of manufacture. Another possibility that your husband might think to discuss with his physician is that his symptoms relate to some degree of adrenal insufficiency and that,even though it is very rare, it might be worth getting an anti 21-hydroxlase antibody test done. Finally C-peptide, a product of the insulin precursor, has been shown in a small study from Sweden to be of limited value in glucose control.

DO'B

Original posting 24 Sep 1998
Additional comment added 12 Oct 1998
Posted to Research: Other

  
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Last Updated: Tuesday April 06, 2010 15:09:00
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