BYETTA

Re: Anyone use Byetta?

fiona35 said:

Has anyone injected and then eaten a couple of crackers straight away and then eaten their main meal around an hour and half later from injecting and would this maybe help with the nausea?

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Hi Fiona, and welcome to Tinam,
I not sure your idea would work Fiona. When a non-diabetic starts to eat, the arrival of food in the stomach triggers the production of hormones called GLP-1 and GIP. These hormones signal the pancreas to start producing insulin which will be needed once the carbs in the meal have been converted to sugar. This is called first-phase insulin production. Once the cycle has started then, with the continuing arrival of more food, the pancreas will continue to produce as much insulin as is needed to deal with the additional blood sugar. This production of insulin in response to the meal is second-phase production.

A problem that is now known to be quite common in type-2s is that part of our autoimmune system, an enzyme called DPP-4, attacks and destroys GLP-1 before it can reach the pancreas. So our pancreases never get the signal to start and so aren't ready when the blood sugars start to go up. Phase 2 then either doesn't happen or is a pretty half-hearted affair. This autoimmune attack is believed to affect as many as 40% of type-2s - but as yet less than 1% of type-2s are on Byetta. Byetta contains another hormone, exendin-4, which is very similar to GLP-1, but is not attacked by DPP-4. Your pancreas recognises the exendin as it's signal to start producing insulin.

If you take the Byetta shot then your first-phase production will start. But I'm not sure if the carbs in a few crackers would be enough to get the pancreas into second-phase production. First-phase production doesn't last very long so the risk is that, with no further food coming in, your pancreas will have shut down again before your main meal. You could try it but there is a danger that getting the first-phase going with insufficient carbs could result in a hypo. You might need a hypo-stop handy just in case.

Re: Anyone use Byetta?

Well done Fiona, that's great news. I'm sorry but I can't remember whether you are on the 5μg or 10μg dose. I think we (and I include some of the consultants in this) sometimes tend to think of 10μg as being the "normal" dose, with 5μg as simply a stepping stone towards it. Your pre-prandial readings are almost at hypo levels, so if you are on 10μg, it could be that 5μg is as strong as you need. If you are currently at 5μg then your readings certainly don't indicate any need for you to be on the stronger dose, and you might want to consider a small increase in carbs to raise the levels slightly.

Like you I suffer from higher readings in the morning than in the evening. My own consultant recommended that either a protein snack (handfull of nuts or small piece of cheese on a cracker) or a brisk 20 minute walk at about 10pm would help to suppress the liver's production of unneeded glucose, which is generally what causes the higher morning readings. My morning readings are often 1.5 to 2 mmol higher than the evening ones, but as they are still quite low I don't worry too much about it.

Re: Anyone use Byetta?

Tina,
If you look back at the posts on page 9 of this thread, I gave some tips that others have found helpful in overcoming the nausea. Unfortunately if these don't work for you then all you can do is hold on, because eventually your body will recognise Byetta as friendly and will stop trying to reject it. For most people it lasts for between 3 and 10 days, but in a few cases it can take a long time - one of our members suffered for a couple of months before it subsided. There have been a few cases where they body just continually rejects the Byetta, but these are pretty rare.

Re: Anyone use Byetta?

Hi Tina,
Unfortunately the nausea does return when you move up to the 10μg dose, so as it is taking you quite a long time to adjust to the lower dose, my own opinion is that you would be better staying on the lower dose for a second month and then move up. If you were to switch up to 10μg almost as soon as your body has come to accept the 5μg dose, you would almost certainly get a violent reaction to the higher dose. At the end of the day its your doctor's decision, but if you explain the situation to him I'm sure he will listen.

It certainly wouldn't do you any harm because the lower dose seems to be bringing your sugar levels down steadily. Of course you can help that process by reducing the amount of carbohydrates in your diet, not by a huge amount but just a little (if you usually have 2 slices of toast, have one instead; if you normally have 4 potatoes, try having 3).

Re: Anyone use Byetta?

Hi Fiona,
I wouldn't recommend moving up to the higher dose until you have been nausea-free for at least 3 weeks. I have seen quite a few cases of people being moved up from 5 to the 10mcg when their systems have only just come to accept the 5, and the nausea they experience is far worse than they had on the 5 level. So much so that in many cases the patients have had to stop the medication completely. It is just so unnecessary - all it needs is a little patience from the HCPs and for them to actually listen to what the patient has to say. They may be the medical experts but you know your own body far better than they ever will!

Re: Anyone use Byetta?

Hi Jane,
The nausea you are experiencing is not at all unusual when starting Byetta. I know that it's unpleasant and you feel pretty rough but it does wear off eventually, in most people in a week to 10 days but longer for some. A lot of people have found that having the injection immediately before you eat can help to reduce the nausea. In fact the longer the gap between injecting and eating then the more likey that you will have nausea. Have a look at some of the posts a couple of pages back on this thread for some tips that might help with the nausea.

Hang on in there if you can - believe me the benefits are huge.

EDIT - forgot to ask - were you started on the 5mcg dose?

Re: Anyone use Byetta?

Hi Tina,
That's great news and well done for sticking with it. I appreciate that its very difficult but nearly everyone I have met on Byetta has agreed the end results are well worth the early pain.

As it has taken you so long to become acclimatised to the 5mcg pen I would certainly recommend that you ask your DSN or GP to keep you on the lower dose pen for a further full month. Unfortunately it is likely that the nausea will come back when you move up to the 10mcg dose, but generally people who are allowed longer to acclimatise to the 5mcg suffer less and for a shorter period when the dose is increased.