returning to Byetta

Hi bbsue, sorry I didn't respond - somehow I missed your posting.
To deal with your points one at a time:

According to the manufacturers you can only take byetta up to an hour before you eat. What it does is to trigger the pancreas into starting insulin production (this is called first phase production). Then as the pancreas recognises that food is being eaten it will continue to produce insulin on its own (second phase production). If you take byetta more than an hour before you eat, you will get the first phase production, but then the pancreas realises that there is no food for it to act on so it shuts down again and never gets into second phase production.

Now this can be overcome if you also take gliclazide, because gliclazide just forces the pancreas to produce insulin whether there is food in the stomach or not! But from what you have said you are on pioglitazone, not gliclazide. Pioglitazone does not help you to produce more insulin - it just makes the insulin that you do produce work more effectively (i.e. it reduces insulin resistance). Pioglitazone can have some nasty side effects like fluid retention and very rapid weight gain (and I mean up to a stone per month!!). So this is something you will need to watch for.

As you have said, a morning BS of 7.5 is not drastically high. Its just a shame that you seem to react so violently to byetta and I am surprised that they would want you to continue with it. Have they suggested that you try sitagliptin (Januvia) instead? It works similarly to Byetta but is taken in tablet form and is less prone to causing nausea. Many endocrinologists believe that Januvia is not quite as powerful as Byetta, but as your starting BS level is not that high perhaps this is something that might work for you?

Hi bbsued, I was at first quite worried by what Lloyds had told you,because this is at odds with the information that comes with the pens. The pen leaflet says that the pen must be refrigerated most of the time but can be kept for up to 7 days unrefrigerated. The pen pack leaflets were last revised in September 2007. However I have had a look at the clinical guidelines that are issued to GPs and pharmacies and they say:
"STORAGE
Prior to first use, BYETTA must be stored refrigerated at 36ºF to 46ºF (2ºC to 8ºC).
After first use, BYETTA can be kept at a temperature not to exceed 77ºF (25ºC). Do not
freeze. Do not use BYETTA if it has been frozen. BYETTA should be protected from
light. The pen should be discarded 30 days after first use, even if some drug remains in
the pen."
These instructions are dated October 2007 so are more recent than those that come with the pen packs. It looks like Lloyds may be right, but personally I don't take any chances and keep mine in the fridge. It is very easy for temperatures, even in our temperate climate, to exceed 25ºC, as they did in that warm spell we had a few weeks ago.

Good luck on your second try with byetta - let us know how you get on.

on http://www.byetta.com it states:

How should I store my BYETTA Pen?
Prior to first use, store your new, unused BYETTA Pen in the refrigerator at 36°F to 46°F (2°C to 8°C) protected from light
After first use, your BYETTA Pen can be kept at a room temperature not to exceed 77°F (25°C)
Do not freeze BYETTA. Throw away the BYETTA Pen if it has been frozen
Do not store your BYETTA Pen with the needle attached. If the needle is left on, BYETTA may leak from the pen and air bubbles may form in the cartridge
When carrying the pen away from home, store the pen at a temperature not to exceed 77°F (25°C) and keep dry
After 30 days of use, throw away the BYETTA Pen, even if it is not completely empty
Keep your pen and needles out of the reach of children

There are more and more UK diabetologists looking at Byetta, including those like me who are insulin. One doctor wrote on a medics forum

'Had an interesting talk with a US diabetologist recently. She has nearly 1000 patients on exenatide, and says essentially they all respond, if you give them long enough. Over a few months their weight comes down, followed by their BGs. For those she starts who are on insulin, she gradully withdraws it rather than stopping at outset. No time limit for duration of insulin therapy - she has one who had been on insulin since 1965 who has responded nicely. Other useful bit of advice was that nausea is partly caused by meal taken after a jab. No meal no nausea. Certainly not necessary to eat within 60 mins. She tells hers only to eat if they are hungry (!?). Our more limited experience in Colchester is similar.'

I am still very keen to add it to MF and see how much my insulin can reduce.

Hi Marty,
Nice to hear from you again - are you back at work now? Always good to learn more about exenatide. I was surprised that in the user group in the States that I correspond with there are quite a few who are on byetta and insulin, even though Lily don't recommend it. I think the lack of recommendation is only because they haven't fully tested that specific combination. They have nearly all found that they have been able to gradually reduce the insulin dosage to minimal levels.

Several in the US group have reported hypos after taking byetta and not following with a meal. Not surprising when you realise the byetta triggers first-phase production in expectation of food to follow. With no food the insulin produced in first phase will just send the BS lower and lower.

Dennis at my latest Byetta review in Worthing the Spec Nurse admitted that Byetta is taking off big time and that a lot more T2s on Insulin are being switched.

With the keeping cool issue i rang Ely Lilly. their line was that it was more to do with keeping it safe prior to Issue ( dont want comebacks ) as they cant control the environment that we use it in.

Off to earn a crust
DP

dennis

i keep my byetta pen in the fridge when it is in daily use, is this wrong? i thought it was the coolest place for it.

Hi Pauline,
Looks like Eli Lily have relaxed the instructions about storage once you have started to use it. Before first use it must still remain refrigerated, but once you have started to use it they are now saying that it only has to be kept below 25ºC. There is nothing wrong with keeping it in the fridge and that is what I do. The relaxation of the rules just means that if you are going out for a meal or to see friends, it is no longer necessary to keep the pen chilled all the time.

If flying I would still take it in a Frio bag because the temperature inside cabin luggage and passenger areas can sometimes exceed 25ºC. Same applies if travelling to a hot country.

Hi Dennis

Yes- back to work almost fully now. About to stop my antibiotics for the bone infection. Its been 6 months- a wee bit aprehensive now.

I really want either exenatide or sitagliptin. There seems to be more and more pressure to use it in insulin users. Currently on 84 levemir and 30-50 novorapid per day and I would hope to reduce my doses significantly. There are one or two studies now published looking at exenatide with insulin treatments.


All hail to the lizard.