Re: Anyone use Byetta?
Firstly, many thanks to everyone who has posted their experiences on this tread. I've read through the
entire thread during my research to lower my Bg.
I am type 2 diagnosed in 1996 in Southern California. Consider myself extremely fortunate to have a friend who strongly recommended that I see a top endocrinologist at a place called Scripts in San Diego as my (American) GP was not adequately addressing the problem. I immigrated to England with my wife (who was born here) in 2006. (For those who ask, "Why?," I can tell you that, overall, life is far better in England than America. Really.)
My diabetes medication for the last 5-6 years:
Metformin 1,000mg 2x daily
Glibenclamide 5mg 3x daily (2x AM; 1x PM)
The last two years I've had a very difficult time controling Bg. Waking up is the worst with a range from 10.0 to 12.7 or so. It doesn't seem to matter what bedtime numbers are. I can go to bed with 4.4 or 7.0 and still wake up with 10-12.7. Some days the Bg would come down within a couple hours. Other times it wouldn't get below 7.0 until mid afternoon (I'd even have eaten the same food in both cases). Depressing, really.
BMI 29.5
HbA1c's over the last two years:
6.7% Dec 2006
8.6% Nov 2007
9.1% July 2008
8.4% Nov 2009
I spent several days researching what the next step should be as, until this month, the "diabetic clinic" (in name only as there are no professional qualifications in diabetes or endocrinology) at the local surgery provided no meaningful guidance to get my numbers to a safe level. Comments such as, "it could be just a blip in your HbA1c's," is one, unhelpful, example of the feedback.
Thus, I started researching insulin on my own to learn more as, based on my experience, those at the surgery didn't initiate a treatment regime even after the 9.1 HbA1c result. During this research to find the best insulin treatment for myself I came across Byetta and Victoza and some oral medications (which I quickly discounted).
After studying the various papers, I felt Byetta would be the best in my case. I liked that it worked in a different way to my current medication, i could add it to my current medications (perhaps at a lower dose of Glibenclamide). The medical profession
always drives home how important weight loss is and that seemed a far better possibility than a weight gain with insulin.
There seemed to be a large percentage of patients with GI side effects. Still, it seemed worth a go. Even more so that in the past I very rarely experience side effects from medication. (Fingers crossed.)
At the "diabetic clinic" a few weeks ago, I advised the nurse that I wanted to start on Byetta. She smiled. She had to talk to the doctor that deals with diabetes at this surgery and someone would get back to me.
After a day and a half with no word I emailed the surgery inquiring about the status. The doctor advised (rather strongly, I felt) against Byetta. He said I should be on insulin and that was his recommendation and to come in and talk to him.
I was upset. I'd read the latest NICE guidelines (#87). I'd read the clinical papers and summaries on Byetta. I'd read
all of your experiences in this thread. I checked public reports from my PCT which proudly stated the "Quality Prescription" level they feel they've achieved and the fact their PCT's prescription costs 6% below the national average.
I was ready to battle it out with the doctor this morning during our consultation.
Listened to all he had to say; I didn't say a word until he was done. Did find some of what he stated was not quite 100% accurate. For example (paraphrasing):
Byetta will only work for about a year at which point you will have to go on insulin anyway; so you might as well get started on insulin now.
We can only expect to get a 1 point drop in your HbA1c (from 8.4% to 7.4%) so it's not enough of a reduction on Byetta anyway.
A problem with Byetta is there are only a couple dosage levels. You start and the maximum you can go up to is '10.' But with insulin there is no upper limit. [Note, he got the dosage and time-frame wrong. I politely corrected him.]
While I would quite likely been able to hold my own based solely on the papers I'd read (including, oddly enough, the NICE guidelines) it was the
wealth of information all of you provided in this forum that helped give me the confidence to go and firmly tell this doctor (not my regular doctor) I feel Byetta is a superior choice to get my Bb back to a safe level.
The doctor agreed to put me on Byetta stating that I made my case. I think his justification for prescribing Byetta was my bringing up weight and BMI. At the end he said that Byetta could be prescribed in cases where weight is a concern. If that is all he needs to justify prescribing Byetta, I'm not going to argue.
After that was settled, he inquired as to how often I tested. I told him it varried based on what I ate, my activety level, state of health and if I felt a hypo or not. Then figured it was, perhaps, 2 to 3 times a day. Some days I don't test at all.
His response was "That's too much. You only need to test that many times a week." I put on my "oh, that's a surprise" look and then identified the root of his comment: expense. I'd read of the push to not offer home testing to Type 2 diabetics claiming that HbA1c tests are all that is needed. When first diagnosed my American GP never mentioned home testing. I had
no idea of the effect food or exercise had on my Bg. When I switched seeing an endocrinologist, I realised I was mucking about in the dark without home testing.
So I shall start on Byetta once (I assume) he consults with an endocrinologist and gets one of the practising nurses trained in administering Byetta. I've already read the instruction online and view the online demo a couple times. Will review it again before my appointment with the nurse as my level of confidence in their experience is low.
To hear what all of you have experience -- regardless if the experience was positive or not -- was a tremendous help.
Thank you ... all of you.
I shall post my Byetta experiences here in the hope of adding to the information already available ... hopefully shorter posts in the future.
