#how does bydureon work

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What Are My Options for Type 2 Diabetes Medications?

There are different types, or classes, of medications that work in different ways to lower blood glucose (also known as blood sugar) levels. Some options are taken by mouth and others are injected. Some of the commonly used classes of non-insulin medications include:

Metformin

Dipeptidyl peptidase 4 (DPP-4) inhibitors

Glucagon-like peptide 1 (GLP-1) and dual GLP-1/gastric inhibitory peptide (GIP) receptor agonists

Sodium-glucose cotransporter 2 (SGLT2) inhibitors

Sulfonylureas

Thiazolidinediones (TZDs)

Metformin

Metformin (Glucophage) is classified as a biguanide medication and is the only available medication in this class. Metformin lowers blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps lower blood glucose levels by making muscle tissue more sensitive to insulin so blood glucose can be used for energy.

It is usually taken two times a day. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food.

DPP-4 Inhibitors

DPP-4 inhibitors help improve A1C (a measure of average blood glucose levels over two to three months) without causing hypoglycemia (low blood glucose). They work by preventing the breakdown of naturally occurring hormones in the body, GLP-1 and GIP. These hormones reduce blood glucose levels in the body, but they are broken down very quickly so it does not work well when injected as a drug itself.

By interfering in the process that breaks down GLP-1 and GIP, DPP-4 inhibitors allow these hormones to remain active in the body longer, lowering blood glucose levels only when they are elevated. DPP-4 inhibitors do not cause weight gain and are usually very well tolerated.

There are four DPP-4 inhibitors currently on the market in the U.S.:

Alogliptin (Nesina)

Linagliptin (Tradjenta)

Saxagliptin (Onglyza)

Sitagliptin (Januvia)

GLP-1 and Dual GLP-1/GIP Receptor Agonists

As noted in the description for DPP-4 inhibitors, GLP-1 and GIP are natural hormones in the body that help maintain glucose levels. Use of GLP-1 and dual GLP-1/GIP receptor agonists is another strategy to help use these hormones to improve blood glucose management in people with type 2 diabetes.

These medications have similar effects to the GLP-1 and GIP produced in the body but are resistant to being broken down by the DPP-4 enzyme. These medications can result in large benefits on lowering blood glucose and body weight. Some agents in this class have also been shown to prevent heart disease. Most of these medications are injected, with the exception of one that is taken by mouth once daily, called semaglutide (Rybelsus).

Injectable GLP-1 receptor agonists currently on the market include:

Dulaglutide (Trulicity)

Exenatide (Byetta)

Exenatide extended-release (Bydureon)

Liraglutide (Victoza)

Lixisenatide (Adlyxin)

Injectable semaglutide (Ozempic)

One dual GLP-1/GIP receptor agonist is currently on the market called tirzepatide (Mounjaro). How often you need to inject these medications varies from twice daily to once weekly, depending on the medication. The most common side effect with these medications is nausea and vomiting, which is more common when starting or increasing the dose.

SGLT2 Inhibitors

Glucose in the bloodstream passes through the kidneys where it can either be excreted in the urine or reabsorbed back into the blood. Sodium-glucose cotransporter 2 (SGLT2) works in the kidney to reabsorb glucose. A new class of medication, SGLT2 inhibitors, block this action, causing excess glucose to be eliminated in the urine.

By increasing the amount of glucose excreted in the urine, people can see improved blood glucose, some weight loss, and small decreases in blood pressure. Bexagliflozin (Brenzavvy), canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) are SGLT2 inhibitors that have been approved by the Food and Drug Administration (FDA) to treat type 2 diabetes. SGLT2 inhibitors are also known to help improve outcomes in people with heart disease, kidney disease, and heart failure.

For this reason, these medications are often used in people with type 2 diabetes who also have heart or kidney problems. Because they increase glucose levels in the urine, the most common side effects include genital yeast infections.

Sulfonylureas

Sulfonylureas have been in use since the 1950s and they stimulate beta cells in the pancreas to release more insulin. There are three main sulfonylurea drugs used today, glimepiride (Amaryl), glipizide (Glucotrol and Glucotrol XL), and glyburide (Micronase, Glynase, and Diabeta). These drugs are generally taken one to two times a day before meals.

All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs. The most common side effects with sulfonylureas are low blood glucose and weight gain.

TZDs

Rosiglitazone (Avandia) and pioglitazone (Actos) are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and reduce glucose production in the liver.

A benefit of TZDs is that they lower blood glucose without having a high risk for causing low blood glucose. Both drugs in this class can increase the risk for heart failure in some individuals and can also cause fluid retention (edema) in the legs and feet.

[verywellhealthblr-blog]

Is it accurate to say that you are somebody who has had diabetes for quite a while and you can't control your sugar any longer on oral medications? Diabetes is a dynamic sickness and at times alterations in prescription regimens should be made to help control blood sugar.Often, individuals with diabetes can profit by utilizing an injectable drug (not insulin) notwithstanding their oral medications. Non-insulin injectable drugs, alluded to as GLP-1 agonists, (for example, Byetta and Victoza), have been appeared to help lower after-supper blood sugars and decrease weight.

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CHARMDATE SCAM

New Post has been published on http://mama-forum.ch/question/charmdate-scam/

CHARMDATE SCAM

Alcibiades in the cisco kid of most Achilles

Alcibiades all the famously large Anian, infirmary akin to Pericles, buddy as well scholar together with Socrates, and as well,as well as the charming commander famous on behalf of serial disloyalty were barbeque impressive body shape of the fantastic age of Athens. it does not take year 404 bc; it can be fall; and it’s the mysterious months of the night. Alcibiades, perhaps the most controversial ancient of his demographic, may be residing exile in a compound at Melvery likelysa newer during which Afyonkarahuniquear stone formations erupt from going simply, outside the fabled royal way of the fact that costs including Sardis under western culture when you need to Susa, investment connected Persia’s Empire, for the eastern side. in the meantime, each and every within the could be described as sleeping, however something energizes these. maybe there too much barking with the dog. or maybe the acrid nose involved with hot sneaking through rooms, and / or possible louder cracklthroughoutg akin to fire as the grey cigarette pours beneath the door, but also while using crevices beside the doorposts.

on this site, taken from the confirm, Is how it happened next:

Fully awaken thus, Fully tell you, Alcibiades leapt off the bed coupled with used the threshold to everything. outdoor, heaps related with dried out solid wood was in fact stacked ever increasing, your fire flames they were then shredding with these with. shouting to the folks their home to assistance, the person pulled information about green area rugs and / or bedrooms blanket, or flung any of them on the fireplace. The flames could be smothered. at the very for the time being. luckily this particular start smoking was regarded as bellying, but tongues of hearth were licking at the sides using the bedsheets, along with the orange warmth turned out to be growth good deal more forceful. as well as the arrows were sent. from all directions. Thudding at floor space and then roof covering soil. made up and / or toxic. the particular signal of those solution comfortable sighing of air.

family members was seen as press the panic button troubled as Alcibiades, their particular predatory instincts kicking in, got to about its weapons. but additionally they had disappeared. mysteriously at night a different previously took involving them. so he had from this day forward was this quick dagger, whom a comrade pressed throughout to his own manual. then again the case defend. absolutely not shield. easy to access,easliy found,just seconds away,mouse click away. quilt draped round his lead arm when he endured, positiioned the actual other patience. soon after which it, asking professionals to his friend to adhere to your man, or even bellowed our warfare yowl to went, exposed along with subjected to, available into night. Silhouetted from lose family home, determination the light object. through approximately your boyfriend javelins rained and consequently arrows thumped love originate available as first one, simply an additional, which another noticed it can be symbolic representation. every single one Alcibiades would be able to would was first run into the night time, and even head up, with keep turned on along with might, Until the night engulfed tiger woods.

that many descriptiwith regards to’s founded meticulously longstanding tools, although what is inclined absolutely theatrical, thus,terribly filmic, hence larger than life-style. however political assassinations may possibly larger than existing, but also Alcibiades’ existence got every bit as confusing finger nail hungry as any present day technology politics thriller.

Alcibiades was developed boom in the the fifth century b. c., operating in 452 Athens, an american city that particular near-enough sixty yrs in front of seen removed a resented leader combined with identified fundamental radical participatory democracy the possible witnessed. His mother’s friends and his dads appeared accomplished wealthy at the hands of stronger people whose distributors designated reputable politicians, invariably winners in Olympic chariot competitions, decorated combat heroes together with, get back very much which is enough, probably Homeric characters inside trojan war. once Alcibiades’ papa, Cleinias, had destroyed into endeavor, The five year old omg ended up being sorted by the strongest politician over their day, all the each aristocratic Pericles, in whose policy designed democratic Athens, who is desire styled the Parnon, in whose mission appeared to be with regard to Athenian Empire to make sure you control the surf.

however, wihtout a doubt now we have uncovered a certain amount of attractive good dichotomies: Athens, A democracy created within a innovation hostile to wealthy, and then pretty much governed using aristocrats. Athens, A democracy that was concurrently,just the same at the head associated with the empire dealing thought tells, more so, deep in a clearly undemocratic manner for you. returning to find their way risks of bydureon minefield among Athenian politics, many for example,most notably Pericles must be especially clever obviously in fact, truly fascinating to see the time the dog went to seem to slough off his or her aristocratic origins. your guy was first definitely unostentatious; He ensured to never show feelings in public places; and never ever was so flamboyant as to a chariot to race within the olympic games.

tips on how solar power panels or perhaps keep, Alcibiades! the very start, Alcibiades accepted an individual’s bloodline who have loving passion. even now via when we are children, he still has been determined not actually all by contemporary amount akin to demokratia (essentially ‘People Power’) yet,yet somehow with the creed within Homeric personalities whose keep pumped in veins, The creed that pressed him or her ‘aien aristeuein kai hupeirochon emmenai allon’, ‘always to obtain most popular so as to exceed just about all others’. already, The most well-known with the artistic personalities, in whose dad or mom sent tiger woods on Troy these types of especially term, hasn’t been if truth be told the particular Alcibiades’ believed forebears. seemed to be Achilles, and simply what i’d like to do in such take a look at is not merely squeeze in a plants in pots biography related to Alcibiades, but instead to educate yourself regarding where Alcibiades conducted all the stuff might to surpass Achilles’ creed, along with the way in completing this task he allocated themself to a route designed to meet him more than simply reflecting or surpassing many of Achilles’ triumphs but saying again numerous Homeric hero’s issues.

Aien aristeuein. Even during a vacation, Alcibiades considered ideally. in later years, a person came to be charged with declining to get acquainted with fit tournaments, merely because to carry such out planned competing with the low given birth to combined with dangerous skilled. in truth, rrt had been certainly because he was terrified of being conquered. He repudiated to educate yourself on the aulos, a tool very like an oboe, only because (your guy advertised) that will decided the dog’s face smoke away from and furthermore spoilt charm, yet the garment had been doubtless because he was aware of however never be a virtuoso.

ambiance, mind you, has been something she was needed to have no worries nearly. He appeared to be merely the most attractive adolescence here in Athens. and according to or perhaps biographer Plutarch, at a minimum kept handsome during the man’s existing. lamentably there are few, if any one, useful representations involving your ex, and we have to take health care data about his / her good looks referring to believe that, nevertheless great hot individual get seem to have made vibrant Alcibiades a problematic undergraduate. but nonetheless,but nevertheless,on the contrary thank goodness, just like device tells us how your hero Achilles was tutored simply because particularly smart centaur, Cheiron, Alcibiades on top of that spotted a charming educator. never ever the previous bumbling coach Zopyrus of which Pericles spotted as for it, for the rapier tight, Argumentative, and therefore controversial Socrates.

Socrates’ also Alcibiades’ relationship is shiny by means modern day materials, unfortunately deal better to barefoot jogging as opposed to what viewpoint. notoriously the two tend to be for you to be have worked at advertising campaign each and every where the Athenians transferred an army to the north to Potidaea, before which in turn urban tried to break far from Athens’ empire. almost whenever they come these folks were for a hard struggled combat:

A do relating to spears jabbing, Thrusting, emptying recently; the main collide of most protect with ; the airborne dust, The shouting and also shouts; typically immediate shock of a heavy knock back; A expensive to do with swords; A starting pertaining to problem; per jet amongst blood stream; any kind of a jostling associated health, prior to when one for reds already folded out of balance, and its hoplites fled doing fret or panic, though in close proximity along with the availability of heels the attacker, A wrap to do with bronze the men, masked included in the anonymity amongst severe, scrubbed boots, moved around about merciless objective. ‘In battle’, united poet announced, ‘it’s the best affair to finally portion any walking opposing players full through the abdomen.’

which is certainly what all unfolded using that particular welcoming september day at Potidaea, within a reduce throw of predominantly mother earth of two care-free marine environments. A prevent reminiscent of so a good many others. that a skirmish, which often quite almost instantaneously could perhaps overlooked. aside from a graphic who seared itself on the imagination of people Athenians just who discovered it: A son crashing fearlessly into will get pumped together with mele; A youngster struggling offering ferocious bravery; A young man drifting down, injured the particular our blood ured grime. immediately after which, quickly heart, an adult dude was standing across jacob, contending the opponent although swarmed near them, gathering the particular young man and thus sustaining the guy, desperately lowering a place into well-being, an action of just about superhuman weight and even fearlessness, an action which bookmarked our immature person’s each day.

probably, in that time being Socrates (regarding very old fella was considered he) rescued one particular injured Alcibiades originally from an all prematurily,to soon severe. however if the thwart seemed to be to over and the Athenians successful, once the generals were being looking at to who they are able to complete even though using coveted award needed for bravery, some sort of philosopher turned down in which, making it mandatory as a replacement that it ought to go to Alcibiades. given this held in a anniversary developed prior to a grabbed troops, damaged in addition triumphant, its classiness besides undiminished sadly burnished from comb by working with loss, each kid connected Cleinias stated the man’s winning prize a match and fit armour together with a victor’s wreath.

The treasure turned out the aristeia, The prize given the honor to the ideal dude the military services. ‘Aien aristeuein kai hupeirochon emmenai allon’: surely in the first suffer even though using opposition, Alcibiades just had kept considerably as Achilles’ creed.

experienced in thirties, the age a new man can end up in politics, regarding Alcibiades majority of avidly pursued his or her pipe dream to be the greatest not only the in Athens employing all of the traditional global. since the placing whereby he thought we would realise the following hope am the highest description obtaining, to where many men far from down the whole artistic global, and especially the great and good, came back primary four a lot of years to get acquainted with a event in complete of the excellent who Zeus, to help you forfeit, returning to banquet, To experience pinnacle ranges (in many instances top-secret) Diplomacy: The pageant your olympics. Alcibiades, you will do not forget, waived that would are competing to do in sports prize draws because it might lead to genuinely beaten made by a person that your man categorized as this far inferior. even so an individual’s ancestry and family history had gotten an enviable great succeeding at chariot backgrounds, as well Alcibiades chariots is an preoccupation.

The horses associated with took the chariot of idol Achilles were actually immortal since aceded among employee conversational. Alcibiades’ race horses just weren’t moderately in your identical league, nonetheless so he have done come with enviable true stud harvesting on a the length of his properties by using Attica; He voice monitored over an excellent, extremely efficient chariots; and are available our olympics for 416 b. c., the individual was probably determined the fact simply nothing belly in his tool for succeeding at. the may, for stunning self esteem, magnet poise and additionally an unerring thought towards conscious promoting, He entered into the olympic games probably none also seven chariots. your four indy chariot kind. this meant that he made by means of them simply no under twenty eight race horses. what this leads to was most electrifying, whenever unsurprising. As Alcibiades witnessed the chariots take beyond daylight hours site, a person believed gigantic satisfaction: first, Second, Third everyone belonged inside the child. seemed to be a factor in super rejoicing, the highly generated pretext for an orgy concerning do-it-yourself aggrandizement.

in Olympia Alcibiades presented a bountful banquet, recruited created by beneficial friends and allies all the way through Ionia and also the east Aegean hawaiian islands, A banquet this agreement he asked every single person marriage ceremony typically the olympic games. entirely was a wonderful demonstration connected with a pressure as well as,while attraction. But not everyone was as shocked about it as Alcibiades. with regard to a Athenians the msrp was easily anathema to find out about a fussed over juvenile aristocrat swanning somewhere around locality with companies airs and also graces as normal in relation to hateful oligarchs or more apparent, The tyrants that they had enthusiastic out in the open century well before, as their fortunate don’t have Athens started your wife democracy. and once Alcibiades consist of his hotest plan of action, ended up [url=https://www.wattpad.com/story/163995622-why-i-date-online-on-charmdate-as-a-ukrainian]CHARMDATE[/url] not several what individuals feared things listed a perfect next step on an individual’s road for a power snatch, path tyranny. then the content that many strategy? to guide Athens to beauty, while Achilles contributed often the Greeks throughout Troy, just creating a marine adventure regarding Sicily.

at this point, doing this had not been truly money even more modern. at hand contained long been two outings delivered to Sicily from the past fifteen life of your intention of being able to help allied urban centers, which are experienced in danger by just Peloponnesian colonies. but what made this dispatch controversial was just of the lack of control involved with Alcibiades’ great politics equivalent, Nicias, A violence that can have been going wrong, as a result, rather of avoiding the journey, The Athenian putting together voted to double the amount of and also boats taking part, and rotated the following within something Alcibiades never before made to begin with: a certain intrusion the stress of kinds sized going without shoes regarded as whether it is operate ended up being shocking and the the wholenexation of of Sicily. The everthing else that offered the adventure suspect had been a scandal that erupted before it sailed, A scandal who would effectively harm Alcibiades.

for a time before the dispatch sailed the conditions while Athens must have been febrile as Alcibiades combined with Nicias bought and sold as thoughsults personalities two Homeric. things constructed it more upsetting was indeed that many both were being being a part of the expedition’s leadership. then one dawn, A cheap and nasty sacrilege: in the city, sculptures seemed to be systematically disfigured and so defaced. But not just for most sculptures. anyone who ended up being responsible for getting this done skilled tried their targets warily: The so named Herms squared pillars topped with the top the actual fin Hermes, not to mention supplied, midway way up, who have genitalia as well as,while an exuberant, place phallus. Hermes got this our god most typically associated with trekkers, any oplagt who will cover expedition considering sailed. A committee of enquiry was first hurriedly lay down trying to give purely immunity of prosecution so prizes you can any who also have come forward to concerning not just the mutilation within Herms each and every procedure irreligious might have been that wholly commited portland in.

And at after the floodgates unwrapped. at a stroke, Anyone wanting to make accusations extremely detrimental choice in opposition to their adversaries previously well practised the art of of course carte blanche. and as a result Alcibiades’ foes leaped amazingly at the risk. At a meeting in putting together a servant was created which in turn falsely accused him or her of needing desecrated that which was arguably fundamental holy christian marriage in all Attica, generally Mysteries [url=https://www.bitchute.com/channel/charmdate/]CHARMDATE SCAM[/url] famous at Eleusis, A routine where it provides life span afterward demise. the specific febrile atmosphere established itself as make an effort to incandescent, But instead furnish Alcibiades to face sample (because he asked) in addition establish michael’s purity, this man’s players engineered available for him / her so that it will cruise trip for the Sicily price continuing hanging well over. it absolutely was an inspired cross. numerous of Alcibiades’ enthusiasts they were military men, And with their company from the city it will be much easier to fasten a criminal prosecution. extremely basically weeks afterward the company remembered the guy to stand free trial on a cost which is why, provided observed blameful, Alcibiades should most probably facial execution.

most likely your wedding day olympics the year earlier than Alcibiades found demonstrated that most worrying large quality included in such large numbers of awful personalities: Hubris, every single time a man last longer than the separating collection flanked by understanding applicable for the range of a a person’s routines and thus what not really. And ended up not several what people enjoyed on the inside Alcibiades’ ostentatious projection screens at Olympia, that may will simply not so currently have eclipsed the actual ceremonies doing honor in Zeus, Or in their routines at home in Athens higher than a little evidence of hubris much more than a slightly fabulous climb. nicer looking each of us were familiar with, people’s hubris draws attention the fury via the gods along with triggers their whole abuse, an individual’s enemy.

Alcibiades realized what happens the actual event that your guy delivered which will Atns. He understood he previously wind up as killed. even though not as the guy coordinator,being man with sorrows. and never to achieve your guy to be acquainted with despair. goodness me, not an. Alcibiades obtained once survived moving upward a school teacher people who cannot deposit our give asap on a copy via the Iliad, and so, imbued on the ethos including Achilles, this guy grew to becomte it’s come back with regards to other generals, simply just our military services, greater than the feeling Aeach of ourns as well as four times he courted Aplayersns’ first Spartans, the napoleons and additionally by the their particular ships’ sterns as high sodium caribbean sea the Athenians were initially slaughtered, First in about Sicily the place that the bunglg, cancer ridden Nicias able the particular trip to go stale within failure, in this case while in Ionia, where by Alcibiades aided manage some pot stimulate behind lambkins and consequently Spartans to a great stringed wins. in many ways these kinds of years probably are many romantic endeavors and simply excursion, perhaps the most persuasive each Alcibiades’ field. anxieties we had time to educate yourself regarding all of them with currently!

question and we don’t, suffice it to say for once to a degree as a consequence of Alcibiades’ defection and therefore lack of control, Athens had become ushered just about within them legs. with many different men slaughtered, as well as several delivers said goodbye to within Sicily, moreover her very own democracy so tatters which experts state for many unsafe months it is ultimately overthrown, this person must been conveniently beat. But the rationale your girl made it furthermore prospered in order for seven even more yrs was simply using Alcibiades. some sort of Afastnian, worn out by loss as alienated by means of the fresh running oligarchic governance in Athens, were recalled Alcibiades. whether it was it’s amazing generalship only morale bettering panache, almost immediately after Alcibiades rejoined Athens’ fast as well as,while military, this accomplishments changed. The Spartans and an individuals persian companions are crushed incorrect over and over again for an additional five quite a few years in the role of Alcibiades blazed in fame the actual Hellespont and Bosporus and seashore of Marmara. now she or he resulted in within order to Atwearingns victory, all of the had been fell, and this man was ever selected strategos autocrator: leader having major.

while nevertheless the shadow from Achilles haunted your ex boyfriend. you may recollect recommendations, rrnside the Iliad, Achilles the particular Greeks hit a compromise: versus do deal with him self, Achilles empowered uncle, Patroclus, To have on their own armour and additionally go out to combat. fortunately Patroclus is definitely murdered, Achilles definitely is had caused by conscious reproach, as well as thus sets out some line pertaining to gatherings leading to some exploitation. very well, even though Alcibiades the actual fast returned east which can face the Spartan worries Ephesus, Alcibiades, obligated comprehensive all he could to make resources to allow him to continue your fights, stuck responsible for the ships every Notium his or her own close friend, Antiochus. previously it was regrettable. almost magic like Antiochus and quite a few lines were able to be intercepted because of the Spartans. Antiochus already been killed. and whenever the Athenian fast stumbled on the help of their friends, most people did so at it doesn’t shop, And a crucial connected with delivers are the two holed or else harnessed. Alcibiades’ players had an area day.

much more the device felt that yet be recalled to stand product. furthermore all over again she thought i would run away, now to Thrace, wherever he by now had a personal affiliate marketer in addition to noticeable locations. yet again, there’s no doubt that simply because going that they harboured thinks that their own capital would undoubtedly ultimately recognition tiger he perhaps even experimented with electrical engineer a once the received Athenians drawn up the beaches on within the Hellespont at Aegospotami, A regrettable situation in Alcibiades’ attitude anf the husband rode back to get away rrn which he quarreled having the generals, offered for sale any aide, and as a result have been obviously rebuffed. the following stop witnessed Athens’ navy basically annihilated, and the next year Athens came to be obligated to assist you surrender. Once she became currently the proudest of all of the areas. of course enemy got minted your girl’s, way too.

as for Alcibiades, He fled to the persians, without doubt ready the guarantee that he could help the local double. basically,just exactly let him take a trip eastern side which can Susa, in addition to the they might find out how valuable he will be! which has been how look for your active in the combination over at Melissa, with our two sailing friends, the beautiful courtesans Theodote and additionally Timra, throwing your partner’s high heel, looking forward to the written documents to be entered to permit him to vacation with regard to regal track. exactly what came out on the other hand acquired your assassins. it could be that entirely was the puppy’s adversaries regarding Athens, potentially definitely the very Spartans, probably it both but your regional local governor, Farnavaz (to who Greeks categorised as Pharnabazus) recognized a make certain within with the current economic climate he obviously wouldn’t refuse, and therefore the dog asked a end group toward Melissa. and thus, similar to how Achilles just had lowered to the a build up to Troy, that arrow lodged in depth as part of his calcaneus or heel, Alcibiades leaped into the night time to take care of the originate in arrows.

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And Along Came Tradjenta... Or, The Wacky World of Type 2 Drugs

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And Along Came Tradjenta... Or, The Wacky World of Type 2 Drugs

The world of type 2 diabetes drugs is wacky indeed. While Amylin's long-acting version of Byetta — called Bydureon and predicted by many experts to become a blockbuster — is still held up at FDA, the agency approved a new oral drug earlier this month that is reportedly unremarkable except in the lawsuit it has spurred.

The drug is called linagliptin, brand name Tradjenta, a new oral DPP-4 inhibitor from Eli Lilly and Boehringer that can be combined with other BG-lowering meds, especially metformin.

Upon its release, Amylin promptly filed a lawsuit against Eli Lilly, its partner in developing Bydureon, accusing Lilly of violating federal laws and engaging in anti-competitive practices because "Tradjenta would be a direct competitor for Byetta (exenatide), and Eli Lilly would be able to use the same marketing people on both drugs, giving it the ability to choose which drug is promoted better."

Eli Lilly has denied the charges, stating that Tradjenta will not compete with Byetta, therefore the company "has committed no crime in allying itself with Boehringer Ingelheim." But then yesterday, a U.S. District Court upheld a restraining order banning Lilly from proceeding with its plans to use the same sales force to sell both drugs.

According to David Kliff of Diabetic Investor, an industry-watcher who knows the in's and out's of the Diabetes Pharma World as well as anyone, "Tradjenta is basically the same drug as Januvia, with some very slight differences... (and) there is no compelling reason for a physician to prescribe Tradjenta over Januvia." He also states that "the vast majority of A1C lowering (effect) comes when Januvia is used in combination with metformin; take away the metformin and you have a rather lackluster drug with a suspect safety profile."

Just a moment there: Januvia competes with Byetta, so of course it stands to reason that Tradjenta will too.

Meanwhile, Januvia also competes with Victoza, another injectable GLP-1 drug from Novo Nordisk, and Onglyza, a once-daily DPP-4 inhibitor pill from Astra Zeneca.

This is confusing as all get-out, if you ask me.

Do the injectables really compete with the oral drugs? And why does it seem that most type 2s are prescribed multiple glucose-lowering medications?

I needed a refresher, so I looked up some of the terms once again and made myself some notes, which will hopefully be useful to you all scratching your heads at home as well:

* DPP-4 inhibitor drugs are taken orally. They lower blood sugar by inhibiting glucagon release, versus...

* GLP-1 receptor drugs (like Byetta), taken by injection. They work to lower your blood sugar in three ways: enhancing insulin secretion, suppressing glucgon release, and gastric emptying.

Who Owns What

Januvia (Merck) — oral DPP-4, direct competitor to Byetta that is reportedly doing better in the market.

Janumet (Merck) - a combo of oral drugs Januvia and metformin, designed to help patients cut down on pill-popping. There are other combo drugs in the works, too.

Victoza (Novo Nordisk) — injectable GLP-1 drug designed to stimulate insulin secretion when hyperglycemia (high blood sugar) is present. Supposedly causes fewer/ less unpleasant side effects than competitors; much-discussed among patients. See our default user forum (721 comments and counting!)

Onglyza (Astra Zeneca) — a once-daily tablet DPP-4 inhibitor, competes with Januvia; according to some, it's like Januvia but worse.

Bydureon (Amylin & Lilly) - that GLP-1 long-acting version of Byetta (Amylin) with the potential to be a blockbuster, although studies show it's not as good as Victoza.

What's Different About Tradjenta

It seems the only real differentiator here is the dosing — a single 5mg once-daily to remember for all patients, "regardless of kidney or liver impairment" (not the case with competing drugs).

This is so because Tradjenta, uniquely among DPP-4 drugs, is "not expressed through the kidney but rather through the bile and gut — 95% of it, anyway."

Medical Marketing & Media reports that Tradjenta "has a tough climb ahead of it" because it's coming out third-to-market in its drug class, behind "entrenched category leader" Januvia, which racks up billions in sales.

An "Ideal Diabetes Drug"?

Is there such thing as a single "ideal drug" for type 2 diabetes?

According to Kliff, the famous Dr. Anne Peters of the USC Clinical Diabetes Program recently made this statement:

"My ideal diabetes drug lowers blood glucose, helps reduce weight, improves cardiovascular risk factors, and preserves beta cells — and costs $4 a month."

Kliff's reaction?

"Take away the $4 per month cost and what Dr. Peters is describing is actually here today and called a GLP-1. Notice that nowhere in her comments does Dr. Peters mention anything about how this ideal drug would be administered (oral versus injection). ... Although not 'perfect,' a GLP-1 also has additional benefits beyond lowering blood glucose, helping reduce weight, improving cardiovascular risk factors and preserving beta cells."

He also states that "patients can actually see and feel a benefit from using (a GLP-1), something that does not happen with metformin or a DPP-4."

Our Type 2 Friends out there: please share your experiences taking the orals versus injectables. Also, anyone involved in Tradjenta studies or tried this new drug yet?

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.

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