How does pramlintide act

It decreases the post-prandial glucose levels, acting mainly during the first 30-60 minutes. The mechanisms that have been described concern the inhibition of glucagon secretion and the delay of gastric emptying. These effects are mediated through a central nervous pathway from the area postrema of the 4th ventricle, with centrifugal fibres to the adjacent nucleus of the vagus nerve. The area postrema contains a lot of binding sites for amylin (as well as for GLP-1) and is exposed to the changes of the plasma amylin and glucose, since it is located outside the blood-brain barrier. The presence of glucose is essential for the action of amylin and in the event of hypoglycaemia its actions are suppressed.

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