BYETTA

Re: Anyone use Byetta?

Hi Candy,

I can't really add anything to Dave's excellent response. Thanks Dave.

Re: Anyone use Byetta?

Hi Fiona,

The main purpose of Byetta is blood sugar control. Weight loss is only a secondary benefit. So long as your figures show that Byetta is enabling you to maintain BS control then they would have no grounds for withdrawing it.

Re: Anyone use Byetta?

Hi HLW and Nativenewyorker,

HLW, the NICE guideline is actually rather weird because glitazones and sulphonylureas do totally different things and should therefore be used in different circumstances. One is not a replacement for the other. Glitazones bind to receptors in a body's cells in order to reduce insulin resistance, so they are more akin to a much stronger version of metformin. Sulphonylureas (like gliclazide, glyburide and glimepiride) force the pancreas to produce more insulin. So logically a sulphonylurea should be used where it is believed that a patient's pancreas can't produce enough insulin without extra encouragement. There is an increasing number of doctors (and particularly consultants) who now believe that use of a sulphonylurea to force the pancreas into producing more insulin can burn out the pancreas' beta cells, resulting in the patient being forced onto insulin much earlier than is really necessary.

It is possible to get Byetta on private prescription. Any doctor or consultant should be able to issue you with a private prescription. All chemists are happy to handle private 'scripts because they make a good profit from them. Byetta costs the NHS around £63 per month's treatment, but on private prescription most chemists will charge around £104. The cheapest I was able to find when I initially had to pay for it privately was Boots at £92 a go (I now get it free on the NHS).

Nativenewyorker, I suspect that you probably don't qualify under the NICE guidelines, but that won't stop your GP prescribing it if s/he feels it is right for you. The reason I say that is because your HBA1C is not unduly high (although there is room for some reduction), and Byetta is not licenced for use with insulin and is not supposed to be used with insulin unless there are circumstances that make it impossible to use anything else. On the weight side you probably do qualify, and Byetta would certainly help you there. One thing that seems to be common with most Byetta patients is that the weight loss starts immediately on the lower 5μg dose, whereas the greater BS reduction seems to occur on the 10μg dose. The normal progression (for those that need it) is to take the 5μg dose for one month and then move up to the 10μg dose. You could always ask your GP to keep you on the 5μg dose which would give you the benefits of weight loss but the lower dose would give you a smaller reduction in BS levels. Just a suggestion!

Incidentally it is perfectly normal for there to be ketones in your urine, and testing for them won't give any indication of your blood sugar levels! Ketosis is a perfectly natural body function that occurs whenever you burn off any fat, and the by-product of ketosis is ketones that are flushed out through your urine. I would be inclined to ask your GP why he/she is going against NICE guidelines and the new government Framework for Diabetes guidelines in trying to discourage you from testing.

Re: Anyone use Byetta?

Hi Sammy,

From what you have told us you do seem to fit the NICE guidelines for benefitting from Byetta. As you say your GP is probably concerned by the cost, but as you fit the prescribing guidelines his PCT have no grounds to challenge it if it was prescribed. As Babbettes said, keep pressurising him.

I'm no insulin expert but you do seem to be on a pretty high dose and, as insulin encourages weight gain, it is doing you absolutely no favours in that department. One thing that you might consider is reducing your intake of carbohydrates, particularly the starchy carbs that do nothing for you apart from fill you up! These are wheat products (cake, bread, cereals), pasta, rice and potatoes. I'm assuming that you have already cut out sugar from your diet, although sugar actually does you less harm than the starchy carbs. A reduction in your carbs will do a number of things:
- will help you to lose weight (permanently, not like Weightwatchers and similar diets where it all piles back on as soon as you come off the diet)
- will lower your blood sugar and allow you to keep good control over your BS levels
- Will drastically reduce your need for so much insulin
- will make to feel far fitter and have more energy
- will reduce your cholesterol.
On the minus side - it needs you to think more about your food and understand what you can and can't eat based on what effect different foods have on you. By my book that's not much of a price to pay for feeling and looking good!!

Whether you are allowed Byetta or not, a reduction in your carbs would still do you a power of good. If you would like more information on this then have a look at the low-carb or success stories threads.

Re: Anyone use Byetta?

Hi Phil,

That's quite a cocktail you are on at the moment! Your doctor seems to have looked up every anti-diabetes and anti-cholesterol medicine currently produced and prescribed all of them!

You really don't need to worry about going onto Byetta. It is one of the newest diabetes drugs available and has been proved to be enormously successful. Unlike most diabetes drugs which do only one thing, Byetta provides 5 benefits:
- it triggers your pancreas into producing insulin in response to a meal
- it stops the liver from producing unwanted glucose
- it slows down the rate at which food is converted to blood sugar by slowing the digestive system
- it reduces appetite
- it reduces liver fat content (which encourages greater HDL (good cholesterol) and reduced triglycerides (bad cholesterol))

What I would warn about though is that the manufacturers say you should not take Byetta with the combination of gliclazide, pioglitazone and Lantus that you are currently on. If you do then you could end up with a massive hypo. You will need your doses of Lantus, pioglitazone and gliclazide reduced considerably.

One other thing is that the manufacturers say that Byetta should not be used in combination with other weight-reducing medication, which means either Byetta or Xenical, but not both. Also it is not recommended to use Byetta with ACE inhibitors (like Ramipril) because it reduces their effectiveness.

What you will find, as Dave has already mentioned, is that Byetta is great at stabilising blood sugars, great for weight loss, and can also help with your high cholesterol levels. So go for it - and keep us informed of how you get on.

Just realised, I should have mentioned that it is absolutely vital that you test your BS every day (and at least twice a day) especially while you are also taking other meds that cause hypos when used with Byetta.

Re: Anyone use Byetta?

Hi Mikey and welcome to the forum,

When my consultant first suggested Byetta I have to admit I was absolutely petrified. That wore off a bit when he explained all that it does, but I was still scared stiff of having to inject, because I have always had a needle phobia (I had actually been known to pass out on seeing an injection). But I was amazed at how quickly I got used to it and, after 18 months on Byetta, 3 stone lighter and blood sugars in the normal non-diabetic range, I thank God every day that I happened on a consultant who is a huge advocate of Byetta.

Have a good read back through this thread and if you stall have any concerns then please ask away.

Re: Anyone use Byetta?

Hi Fiona,

I'm not sure where this idea came from that the longer you leave it between injection and eating then the more effective it will be - certainly not from the manufacturers because they have never claimed this. It is not mentioned in either their patient or practitioner literature. The only thing they do say is that the longer the gap then the more likely you are to experience the side effects - as you are now finding.

The idea of Byetta is that it sets off first phase insulin production by your pancreas. In a non-diabetic person first phase is triggered by the stomach recognising that food has arrived and sending messages to the pancreas to get started. The pancreas starts insulin production within a few minutes of the first food arriving, before the food has even been converted into glucose. Depending on what type of carbohydrate is in the food, the conversion of carbs into glucose can take anything from a couple of minutes to more than an hour. This would indicate that logically, the ideal time to take Byetta for it to have maximum effect would be around 15-30 minutes before eating. That would get the pancreas getting its first phase production nicely into gear just in time for the first increases in blood sugar. And also avoids side effects.