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BYETTA

Discussion in 'Incretin Mimetics' started by Dennis, Aug 22, 2007.

  1. Mrs B

    Mrs B · Newbie

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    Check out Dennis- he has been on it for a wee while. He has posted elsewhere on the forum.

    Goodluck
     
  2. shavals

    shavals · Active Member

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    Hi Mrs B

    thanks for the info, have found Dennis's comments and understand it all, just have to wait til I'm called to the Clinic to start it, hopefully it will sort me out.

    Pauline Jones
     
  3. Dennis

    Dennis Type 2 · Well-Known Member

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    Hi Pauline,

    Sorry I didn't respond quicker to your request for info. I've been laid up with a really bad cold all week and haven't been checking the forum posts. I am told by my consultant that there are still only around 80 people in the UK on Byetta, and 55 of those are his patients, so his group seems to be regarded as the cohort group within the medical profession. He complains that he spends more time giving presentations on it to doctors and consultants than he spends with his patients, but it seems to be getting the message home as other consultants want to give it a try.

    I have been on Byetta for almost 6 months now and no problems. Nausea is supposed to be a side-effect for the first week or two, but I didn't experience that at all. The only other major side effect is that it can cause pancreatitis, but it only seems to occur when someone has been on it for a long time, and even then is extremely rare. It certainly is fantastic for weight loss - I have lost about a stone since I started on it.

    If you have any questions about it just let me know and I will do my best to answer. If you have any technical questions, I have found the Eli Lily UK help desk to be very friendly, knowledgable and helpful.
     
  4. shavals

    shavals · Active Member

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    Thanks Dennis

    You've cheered me up, especially about the weight loss!!

    will keep in touch.

    Pauline Jones
     
  5. shavals

    shavals · Active Member

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    Sorry Dennis

    forgot to say hope you're feeling better now.

    Pauline Jones
     
  6. molly

    molly Type 2 · Newbie

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    hi all, just started on byetta-any suggestions for easing the nausea and vomiting?
     
  7. Dennis

    Dennis Type 2 · Well-Known Member

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    Hi Molly,

    With most people the nausea lasts for around one to two weeks, then wears off. During that time try to avoid any food that is highly spiced or greasy. Usually patients are started on the 5mg pen for the first month, then moved up to the 10mg pen. Unfortunately this means that having just got over the initial nausea, you go through it again on starting the 10mg dose, but its not as severe as when you first start.
     
  8. Russ

    Russ Type 2 · Well-Known Member

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    Hi Dennis - I've been in touch with a friend who is one of the few people in England to have been prescribed Byetta. She's not registered here but sent this response to me:

    Russ

    "I was reluctant to go onto it because of the side effects I had read about. I started on the 5mcg dose twice daily, and had no discernable effects at all. I went onto the 10mcg a month later as the doctor suggested, and found that I needed no insulin at all and had some hypos. (On 5 I had been able to halve my insulin dose) I also had some mild indigestion and gut ache, and the feeling of fullness in the stomach, but no nausea. I wanted to go back onto the 5 dose to be able to keep a better balance of food and blood sugar, because the 10 dose meant wild swings and I had to eat lots of naughty things to avoid hypos which defeated the purpose, but 10 is ok if its really necessary. I am still not thin."
     
  9. Dennis

    Dennis Type 2 · Well-Known Member

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    Hi Russ,

    Thanks for passing this information on. I was mystified to see your friend has suffered hypos as all the medical advice says that the only way in which a hypo can be induced on byetta is if it is used in conjunction with a sulphonylurea or if it is not used correctly. It has to be taken up to 1 hour before a meal, but if you take it and then skip the meal it can then cause a hypo.

    Byetta (or exenatide) isn't an insulin substitute and it doesn't act directly on blood sugars. Exenatide augments pancreas response (i.e. increases insulin secretion) in response to eating meals. The result is the release of a higher, more appropriate amount of insulin that helps lower the rise in blood sugar after eating. Once blood sugar levels decrease closer to normal values, the pancreas response to produce insulin is reduced. This means that that byetta is only really suitable for those whose pancreas is capable of producing insulin (but needs a kick-start to do it) and is then able to respond to rises in blood sugar. This is why it is not recommended for people who need insulin, unless the insulin requirement is very low and needed only to augment the pancreas's own insulin production.
     
  10. martinbuchan

    martinbuchan · Well-Known Member

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    Dennis- animal studies show GLPII drugs stimulate bets islet cells to fuction again- could be useful for someone like me who is fairly insuln resistent and pruduces little insulin. The studies on exenatide in insulin users are on going, hence the licence restrictions at the moment.

    I think it shows in type 2 how the other metabolic effects contribute to hyperglycaemic. It makes me wonder if that this is the primary pathology- increased glucagon leads to hyperinsulinaemia leasds to insulin resistance..... and so on. the prediabetic state glucose intolerance might suggest this.

    Use of these drugs may be useful partly as an insulin sparing effect (like metformin for me). Still worthwhile. Cost wise, my Levemir costs more than Byetta for the dosage I am on. Less insulin inbtake would help me lose weight and so on.

    Once I am stabilise with my foot infection I will push for either class of drug again.

    Cheers

    Marty B
     
  11. Dennis

    Dennis Type 2 · Well-Known Member

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    Hi Marty,

    I wasn't aware that it could also stimulate non-working beta cells.

    You could certainly have a point regarding the effects of increased glucagon, and the second major benefit of byetta is that it is supposed to prevent hyperglycaemia by suppressing pancreatic release of glucagon in response to eating, which in turn helps stop the liver from overproducing sugar when it's not needed.

    The third benefit is that of an appetite suppressor, so you don't feel so hongry at mealtimes and generally don't get the munchies between meals. It doesn't put you off food, or change your enjoyment of it, it just makes you want to eat less than you normally would. It is renowned for encouraging significant weight loss - I have lost around 10 kilos in 6 months and I gather that is quite a low result compared to many.

    (as you can tell I am a firm convert to the lizard spit!)

    Unless your PCT is unusually generous (does Scotland have PCTs?), you may have to have it on private prescription, in which case the cheapest outlet is Boots at £92 per 30 day pen - all the others are around £103 or £105. In your case you might be able to persuade the hospital pharmacy to order it for you and you simply refund their costs (the cost price is £68 which would be quite a saving each month).
     
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  12. shavals

    shavals · Active Member

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    Hi Dennis

    I am being shown how to start on exenatide tomorrow lunchtime. Coming off the Actos and reducing the gliclazide but I am staying on Metformin, the dosage I shant' know until I go to the Clinic tomorrow.

    I haven't had to pay for the supply I am starting with (supplied to me by the hospital) , will wait to see what happens when I need to get some more.

    Will let you know how things go.

    regards

    Pauline Jones
     
  13. Dennis

    Dennis Type 2 · Well-Known Member

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    Hi Pauline,

    Welcome to the club!!

    Sounds the same as me. I came off rosiglitazone (same family as Actos) in order to go onto Byetta. I also came off the sulphonylurea that I was on (4mg Amaryl) but since then we have found the exenatide and metformin mix isn't quite enough on its own to lower the BG levels so I have gone back onto 1mg Amaryl and that has worked brilliantly.

    If the hospital is doing it 'by the book' they will put you on a 5mcg pen for 30 days, then move you up to a 10mcg pen. If you have any questions about byetta that I might be able to help with please feel free to ask.
     
  14. martinbuchan

    martinbuchan · Well-Known Member

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    Hi Dennis

    my stumbling block is my newbie diabetologist. The recently retired one was going to put me on byetta. Once I am back working I might think about paying for it myself.

    One thought- what happens if you have a serious hypo and take IM Glucagon. Does it still work?

    Marty B
     
  15. Dennis

    Dennis Type 2 · Well-Known Member

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    Marty,

    I don't know - I've never been in that situation. The only times I've experienced a hypo has been after exercise (like an afternoon digging the garden), so always self-inflicted. I seem to get very early warning signs so am able to self administer a glucose tablet or two. But I don't see why IV or IM Glucagon wouldn't work in an emergency.

    Shame about the Belgian chocs - you'll just have to try the Hotel Chocolat half sugar ones. I promise you won't be disappointed! Hey that's a thought - IV Belgian chocs!! :twisted:
     
  16. martinbuchan

    martinbuchan · Well-Known Member

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    big shame about chocs- it could be a two faced present though.


    I thought exenatide worked in part by inhibiting glucagon?

    Marty B
     
  17. Dennis

    Dennis Type 2 · Well-Known Member

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    Hi Marty,

    It inhibits pancreatic glucagon production, but I don't believe it would effect glucagon applied in response to a hypo. In the 'notes for professionals' it says that all normal anti-hypo treatments can be followed.
     
  18. martinbuchan

    martinbuchan · Well-Known Member

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    Thanks Dennis- I can sleep easy tonight.

    Also found on pubmed a paper that shows exenatide used in pre-diabetics returned their glucose intolerance to normal. As 1 third of pre-diabetics will progress and type 2 and 1 third stay glucose intolerant (and therefore have the same increased cardiovascular risks) it does seem a promising avenue in preventative medicine.

    Marty B
     
  19. shavals

    shavals · Active Member

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    Hi Dennis
    I started my Byetta today, trouble is I can't really see if the dose is in the tube - anything I can do to make sure it is?

    any help would be appreciated.
    Pauline

    Pauline Jones
     
  20. Dennis

    Dennis Type 2 · Well-Known Member

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    Hi Pauline,

    The clear chamber that you can see contains all 60 doses. You will see a grey plunger at the dial end of the chamber. When you prime the pen and press in the button at the end to inject, this plunger moves down the chamber and pushes the measured dose out through the needle. The plunger's movement is so small that it is barely noticeable, but over a week you will see the plunger gradually settling further down into the chamber.

    Don't be surprised if you find a small air bubble form in the chamber after a few jabs. This is normal and the bubble gradually gets bigger with every further injection. One word of advice on injecting is to keep the button at the end of the pen fully depressed until the needle is fully withdrawn. If you release the pressure then, as you withdraw the needle, it can cause a partial vacuum and draw blood back through the needle and into the chamber. If this happens you must not use the pen again. Call the Lily UK help desk and they will arrange for you to get a replacement pen.

    It is also important the the liquid is injected subcutaneously, i.e. between the fat and muscle layers, so make sure you use an appropriate length needle for wherever you are injecting. Your diabetes nurse should be able to advise on needle types and lengths.
     
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