From the Guidelines
When both insulin and glucagon are reduced by the same amount due to lanreotide, the net effect is typically mild hyperglycemia (elevated blood sugar). Lanreotide is a somatostatin analog that suppresses both insulin and glucagon secretion from the pancreas [ 1 ]. Although these hormones have opposing actions on blood glucose (insulin lowers it while glucagon raises it), their simultaneous reduction doesn't result in a perfect cancellation. This occurs because insulin is the dominant hormone in the fed state, so its reduction has a greater impact than the reduction in glucagon. Some key points to consider:
- Patients taking lanreotide should monitor their blood glucose levels regularly, especially when starting treatment or adjusting doses.
- The hyperglycemic effect is usually modest but may be more significant in patients with pre-existing diabetes or insulin resistance.
- Management typically involves dietary adjustments and, if necessary, oral hypoglycemic agents rather than insulin therapy.
- The hyperglycemic effect of lanreotide is dose-dependent and may stabilize over time as the body adapts to the hormonal changes [ 1 ]. It's also important to note that somatostatin analogues, such as lanreotide, can precipitously worsen hypoglycemia in patients with insulinoma, and can result in fatal complications [ 1 ]. Therefore, lanreotide should be used with caution in patients with insulinoma.
From the FDA Drug Label
Lanreotide inhibits the secretion of insulin and glucagon. In healthy subjects, non-significant reductions in glucagon levels were seen after lanreotide administration In diabetic non-acromegalic subjects receiving a continuous infusion (21-day) of lanreotide, serum glucose concentrations were temporarily decreased by 20% to 30% after the start and end of the infusion. A significant decrease in insulin concentrations was recorded between baseline and Day 1 only
The effect of lanreotide on insulin and glucagon when both are reduced by the same amount is not explicitly stated in the FDA drug label. However, based on the information provided, lanreotide inhibits the secretion of both insulin and glucagon.
- The reduction in insulin secretion may lead to hyperglycemia.
- The reduction in glucagon secretion may lead to hypoglycemia. Since both insulin and glucagon are reduced by the same amount, the net effect on blood glucose levels is uncertain 2, 2.
From the Research
Effect of Lanreotide on Insulin and Glucagon
- Lanreotide, a somatostatin analogue, has been shown to reduce insulin and glucagon levels in various studies 3, 4, 5.
- The reduction in insulin and glucagon levels is due to the inhibitory effect of somatostatin on pancreatic β-cells and δ-cells, respectively 6, 3.
- In a study on acromegalic patients, lanreotide decreased insulin and glucagon levels, while increasing IGFBP-1 levels 3.
- Another study found that octreotide, a similar somatostatin analogue, suppressed insulin and glucagon release in Type 2 diabetes, leaving glucose levels unchanged or slightly elevated 4.
Impact on Glucose Levels
- The reduction in insulin and glucagon levels by lanreotide can have varying effects on glucose levels, depending on the individual and the specific condition being treated 4, 5, 7.
- In some cases, lanreotide may cause hypoglycemia, particularly in patients with insulinoma 5.
- However, in other cases, lanreotide has been shown to have comparable effects to other treatments, such as diazoxide, in normalizing glucose levels 7.
Mechanism of Action
- Somatostatin analogues, such as lanreotide, work by binding to G protein-coupled receptors, which inhibits the release of various hormones, including insulin and glucagon 6, 3.
- The inhibitory effect of lanreotide on insulin and glucagon secretion is thought to be mediated by its action on pancreatic β-cells and δ-cells, respectively 6, 3.