Byetta

Hi Pauline,
I've come across three reasons for people being switched from the 10 pen back to a 5.
1. Where they have not been able to overcome the additional nausea that comes with the move up to the 10 pen.
2. Where the 10 was stronger than they needed - as shown by frequent hypos whilst on the higher dose but stabilisation on the lower dose.
3. Where the doctor had been put under pressure by his PCT to reduce the costs and switched the patient to a lower dose, knowing it wouldn't be effective, so that he could say "this obviously isn't the right medication for you so we'll take you off it". Very devious - and probably technically malpractice - but unfortunately true.

I just hope that the last one doesn't apply in your case but it does seem rather suspicious that you should be switched from a dose that has obviously been working for you to one that isn't going to give you the same control. Did your consultant give any explanation for wanting to change you?

Hi Pauline,
I'm sorry to say this but it rather looks like they are trying to get you off Byetta, no doubt on the grounds of cost rather than effectiveness. The 5mg pen costs the NHS exactly the same as the 10 pen, so it looks like they are trying to maneouvre themselves into a position where they can either say that it is no longer effective, or that you no longer need it. I'm afraid that all you can do is to go along with their suggestions, but, bearing in mind that the only diabetes medications that do not encourage weight gain are metformin and Byetta, you can justifiably request to go back onto Byetta if your weight starts to increase when they stop the Byetta completely.

Dennis said:

3. Where the doctor had been put under pressure by his PCT to reduce the costs and switched the patient to a lower dose, knowing it wouldn't be effective, so that he could say "this obviously isn't the right medication for you so we'll take you off it". Very devious - and probably technically malpractice - but unfortunately true.

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Sadly that sounds likely. A friend's endo has a whole bunch of patients lined up to trial Byetta (as you know it appears to be either highly suitable or not suitable at all) first his PCT refused him permission to use it at all, then they agreed he could prescrbie it as long as he didn't bill any consulting time for his followups.

Is the NICE restriction still that you must have failed on maximum doses of two previous meds before it can be used? From what I've read, and heard, I suspect it would be a good treatment for certain types of prediabetes as well as for some but not other versions of Type 2.