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<blockquote data-quote="amateur endo" data-source="post: 185159" data-attributes="member: 33209"><p>Hi Folks, </p><p></p><p>First post here - just finished reading all 131 pages of this discussion.... yep ... 6 days.</p><p></p><p>A bit of intro: male, 55 yrs diagnosed T2 in 2003, last HbA1c was 9.1 down from 9.5 last November. Medication has been 4x500mg metformin slow release; omacor and rosuvastatin. Started Byetta last Wednesday evening on the 5µg dose. Max weight was about 255 lbs in 1995 (comfort eating when my first wife was terminally ill). Slowly struggled to get my weight down and been around 205 lbs for the last year. I became a Dad for the first time aged 44, two boys 5 and 10, got to crack the big D to stay around and help 'em grow up. My Dad and his Dad both had heart attacks at age 61. Took my (tiny) pension early so I can work part time and get plenty of exercise - walking, running but mainly recumbent triking.</p><p></p><p>For the first few years I could get my bg's down with a combination of restricted carbs and exercise and if I went really strict I could get close to normal numbers after 48 hours of working out the bodies carb stores. Recently this hasn't been working so well. I went on a really strict regime in mid January and found that bg's only came down very slowly during the first two weeks. Hence the acceptance that I need some extra medical help - I've been very resistant to taking extra drugs. </p><p></p><p>So far I've experienced the usual symptom of feeling immensly full after much smaller portions. I've always had a strong "dawn phenomenon" - liver inactivaton of insulin and dump of glucose to rev the body up - fasting numbers have historically been in 11 to 14 range wit daytime numbers in the 7 to 12 region depending upon carbs and exercise levels. Last couple of days I've had fasting results 10.2, 10.3 and I've had daytime numbers in the 6 to 8 range so even after 5 days I'm seeing an effect.</p><p></p><p>I've read very widely about diabetes and the various drugs used in its' treatment - hence "amateur endo". A long time ago I had a career in chemistry ....</p><p></p><p>A couple of things to share.</p><p></p><p>1. For a very good explanation of how Byetta and other incretin mimetics work please have a look at the following medical paper by Frank Svec. I can't see the insert link button so you'll have to paste the address into your browsers address field.</p><p></p><p> http://www.jaoa.org/cgi/content/full/110/7_suppl_7/eS20</p><p></p><p>2. Regarding migrating to the 10µg dose - further side effects etc. With the 5µg pen the total daily dose is 10µg, and with the 10µg pen it will be 20µg. I'm planning to ask for a second 5µg pen and start 3 shots per day for a week before I start the 10µg dose. Hence I'll step up my daily dose from 10 to 15µg before making the transition to 20µg. That's why I read through all 131 pages to see if this had been discussed already.</p><p></p><p>The pharmokinetics of Byetta are that it reaches median peak concentration in the body after 2.1 hours and the effect on serum insulin levels is finished by 6 hours, (see page 15 of http://pi.lilly.com/us/byetta-pi.pdf). Hence the requirement to inject less than one hour prior to eating and space doses by at least six hours. With a 5µg pen I could simply take two shots with the evening meal for a few days. Based on the above pharmokinetics I could take the three shots with the three daily meals provided the first and last shots are separated by at least 6 hours and still never exceed the dose from a 10µg pen.</p><p></p><p>So I do 30 days with 5µ pen - regular. The second 5µg pen will last maybe 20 or 25 days with 3 shots per day towards the end, and then I move onto the 10µg pen. </p><p></p><p>I can see this approach would not be favoured by the PCT/NHS as the 5 and 10µg pens are the same price and running 3 shots per day from a 5µg pen effectively increases the daily cost of treatment 50%. However, I'm only talking of a few days to bridge the dose doubling to alleviate side effects.</p><p></p><p>I've got some thoughts on long term effects of Byetta, phase 1 insulin response, beta cell recovery (observed in Byetta treated rodents) etc. but don't want this first post to be too long.</p><p>Best Wishes to you all,</p><p>John.</p></blockquote><p></p>
[QUOTE="amateur endo, post: 185159, member: 33209"] Hi Folks, First post here - just finished reading all 131 pages of this discussion.... yep ... 6 days. A bit of intro: male, 55 yrs diagnosed T2 in 2003, last HbA1c was 9.1 down from 9.5 last November. Medication has been 4x500mg metformin slow release; omacor and rosuvastatin. Started Byetta last Wednesday evening on the 5µg dose. Max weight was about 255 lbs in 1995 (comfort eating when my first wife was terminally ill). Slowly struggled to get my weight down and been around 205 lbs for the last year. I became a Dad for the first time aged 44, two boys 5 and 10, got to crack the big D to stay around and help 'em grow up. My Dad and his Dad both had heart attacks at age 61. Took my (tiny) pension early so I can work part time and get plenty of exercise - walking, running but mainly recumbent triking. For the first few years I could get my bg's down with a combination of restricted carbs and exercise and if I went really strict I could get close to normal numbers after 48 hours of working out the bodies carb stores. Recently this hasn't been working so well. I went on a really strict regime in mid January and found that bg's only came down very slowly during the first two weeks. Hence the acceptance that I need some extra medical help - I've been very resistant to taking extra drugs. So far I've experienced the usual symptom of feeling immensly full after much smaller portions. I've always had a strong "dawn phenomenon" - liver inactivaton of insulin and dump of glucose to rev the body up - fasting numbers have historically been in 11 to 14 range wit daytime numbers in the 7 to 12 region depending upon carbs and exercise levels. Last couple of days I've had fasting results 10.2, 10.3 and I've had daytime numbers in the 6 to 8 range so even after 5 days I'm seeing an effect. I've read very widely about diabetes and the various drugs used in its' treatment - hence "amateur endo". A long time ago I had a career in chemistry .... A couple of things to share. 1. For a very good explanation of how Byetta and other incretin mimetics work please have a look at the following medical paper by Frank Svec. I can't see the insert link button so you'll have to paste the address into your browsers address field. http://www.jaoa.org/cgi/content/full/110/7_suppl_7/eS20 2. Regarding migrating to the 10µg dose - further side effects etc. With the 5µg pen the total daily dose is 10µg, and with the 10µg pen it will be 20µg. I'm planning to ask for a second 5µg pen and start 3 shots per day for a week before I start the 10µg dose. Hence I'll step up my daily dose from 10 to 15µg before making the transition to 20µg. That's why I read through all 131 pages to see if this had been discussed already. The pharmokinetics of Byetta are that it reaches median peak concentration in the body after 2.1 hours and the effect on serum insulin levels is finished by 6 hours, (see page 15 of http://pi.lilly.com/us/byetta-pi.pdf). Hence the requirement to inject less than one hour prior to eating and space doses by at least six hours. With a 5µg pen I could simply take two shots with the evening meal for a few days. Based on the above pharmokinetics I could take the three shots with the three daily meals provided the first and last shots are separated by at least 6 hours and still never exceed the dose from a 10µg pen. So I do 30 days with 5µ pen - regular. The second 5µg pen will last maybe 20 or 25 days with 3 shots per day towards the end, and then I move onto the 10µg pen. I can see this approach would not be favoured by the PCT/NHS as the 5 and 10µg pens are the same price and running 3 shots per day from a 5µg pen effectively increases the daily cost of treatment 50%. However, I'm only talking of a few days to bridge the dose doubling to alleviate side effects. I've got some thoughts on long term effects of Byetta, phase 1 insulin response, beta cell recovery (observed in Byetta treated rodents) etc. but don't want this first post to be too long. Best Wishes to you all, John. [/QUOTE]
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