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Medical Forum / Diseases and Disorders / Diabetes / October 2005

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Byetta (exenatide)

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ragebco@gmail.com - 19 Oct 2005 22:58 GMT
Has anyone heard of this medication?   A friend of mine just visited
the Mayo Clinic and was prescribed this to control her Type 2 ... I
was complaining about weight gain and Avandia and she said this
produces weight loss.  I have not heard of it before.  Thanks,
Susan - 19 Oct 2005 23:07 GMT
> Has anyone heard of this medication?   A friend of mine just visited
> the Mayo Clinic and was prescribed this to control her Type 2 ... I
> was complaining about weight gain and Avandia and she said this
> produces weight loss.  I have not heard of it before.  Thanks,

We've all heard of it.  Some folks have reported weight loss here, but
they've also been having severe nausea as a result of the drug.  Most of
us are watching and waiting to see reporting on the drug once it's been
taken by millions of folks in the open market.

I don't think anyone here is running out to be the next guinea pig.

Metformin is a very well studied diabetes drug with a long history of
safe use in the U.S. and Europe, and it's highly protective against
diabetic complications.  It's also associated with weight loss.

Susan
anon - 20 Oct 2005 01:45 GMT
The nausea leaves in about 2 days - it did for me!! Combined with Metformin
it works really, really well with my sugar level and no more nausea. The
injection is completely painless.

> x-no-archive: yes
>
[quoted text clipped - 15 lines]
>
> Susan
Susan - 20 Oct 2005 02:04 GMT
> The nausea leaves in about 2 days - it did for me!! Combined with Metformin
> it works really, really well with my sugar level and no more nausea. The
> injection is completely painless.

Good luck with it.

Susan
Nicky - 20 Oct 2005 22:06 GMT
> I don't think anyone here is running out to be the next guinea pig.

Given that it's rumoured to increase beta cell mass, I'd be happy to take
it. I've told my quack that I'm happy to be on a UK trial - but unless I
want to really mess up my A1c, I've no chance : (

Nicky.

Signature

A1c 10.5/5.6/<6  T2 DX 05/2004
1g Metformin, 100ug Thyroxine
95/74/72Kg

Sleepyman - 23 Oct 2005 06:57 GMT
>x-no-archive: yes
>
[quoted text clipped - 15 lines]
>
>Susan

I would love to try Byetta and be the next guinea pig. Replace my
Lantus which does cause weight gain. Unfortunately, my A1c (5.0) is
too good. Most reports of nausea that I have read here are mild and
short lived.

Sleepy

----------------------------
"If English was good enough for Jesus Christ, it's good enough for
Texas."
-Miriam "Ma" Ferguson , Texas governor (1920s)
----------------------------
Thomas Muffaletto - 19 Oct 2005 23:37 GMT
here is a question someone asked at the American Diabetes Associations web
site.

Question: Web MD sent me an e-mail a few months ago about a new pill for
type 2 diabetes- from the saliva of a Gila Monster. I accidentally erased it
and forgot the name of it. My Dr & pharmacist dont know its name neither. Do
you know what it is?

ADA: The drug you are asking about is Byetta (exenatide) which is extracted
from the salivary gland venom of the lizard Heloderma suspectum (Gila
monster). This is the first drug in a new class of agents called incretin
mimetics. Exenatide will be used in combination with medications such as
metformin or a sulfonylurea (such as glyburide or glipizide), or with the
combination of metformin and a sulfonylurea, when type 2 diabetes management
has been inadequate with these agents alone. For additional information
check out the following website: www.byetta.com.

Two new injectable drugs have recently been approved by the FDA

Pramlintide (brand name Symlin) is a synthetic form of the hormone amylin,
which is produced along with insulin by the beta cells in the pancreas.
Amylin, insulin, and another hormone, glucagon, work in an interrelated
fashion to maintain normal blood glucose levels.

Pramlintide injections taken with meals have been shown to modestly improve
A1C levels without causing increased hypoglycemia or weight gain and even
promoting modest weight loss. The primary side effect is nausea, which tends
to improve over time and as an individual patient determines his or her
optimal dose.

Because of differences in chemistry, pramlintide cannot be combined in the
same vial or syringe with insulin and must be injected separately.
Pramlintide has been approved for people with type 1 diabetes who are not
achieving their goal A1C levels and for people with type 2 diabetes who are
using insulin and are not achieving their A1C goals.

Exenatide (brand name Byetta) is the first in a new class of drugs for the
treatment of type 2 diabetes called incretin mimetics. Exenatide is a
synthetic version of exendin-4, a naturally-occurring hormone that was first
isolated from the saliva of the lizard known as a Gila monster. Exenatide
works to lower blood glucose levels primarily by increasing insulin
secretion. Because it only has this effect in the presence of elevated blood
glucose levels, it does not tend to increase the risk of hypoglycemia on its
own, although hypoglycemia can occur if taken in conjunction with a
sulfonylurea. The primary side effect is nausea, which tends to improve over
time.

Like pramlintide, exenatide is injected with meals and, as with pramlintide,
patients using exenatide have generally experienced modest weight loss as
well as improved glycemic control. Exenatide has been approved for use by
people with type 2 diabetes who have not achieved their target A1C levels
using metformin, a sulfonylurea, or a combination of metformin and a
sulfonylurea.

The cost of care

Costs vary widely among the different medications. Even the same medication
can vary in price from store to store. Call around to find the best price
for the one you take.

Generic versions of some sulfonylureas are available. These cost less than
brand-name products and in general are reliable. There is now a generic
Metformin (brand name Glucophage).

To save you more money, ask your doctor to prescribe the largest tablet
strength suitable for the dose you need. One 500-mg tablet, for example,
often costs much less than two 250-mg tablets. You can then use a pill
splitter (available at any pharmacy) to cut the larger tablet into halves or
quarters to get the appropriate dose, if necessary. (Caution: some
extended-release drugs will not work properly if they are cut into pieces;
check with your pharmacist or doctor before using a pill splitter.)

Diabetes pills aren't perfect, but they can help to lower glucose levels for
many people with type 2 diabetes. Keeping your blood glucose levels close to
normal will help to reduce your risks for the long-term complications in the
future and help you feel your best today.

Signature

Tom
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ADA's Diabetes Learning Center
http://www.diabetes.org/all-about-diabetes/chan_eng/channel.htm
Information you can trust from the diabetes experts...
Your American Diabetes Association
http://www.diabetes.org/home.jsp
the American Diabetes Association's Message Boards
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> Has anyone heard of this medication?   A friend of mine just visited
> the Mayo Clinic and was prescribed this to control her Type 2 ... I
> was complaining about weight gain and Avandia and she said this
> produces weight loss.  I have not heard of it before.  Thanks,
Julie Bove - 20 Oct 2005 02:29 GMT
> Has anyone heard of this medication?   A friend of mine just visited
> the Mayo Clinic and was prescribed this to control her Type 2 ... I
> was complaining about weight gain and Avandia and she said this
> produces weight loss.  I have not heard of it before.  Thanks,

It's injected twice daily.  I looked it up because my Dr. said he might put
me on it but my A1c wasn't high enough to warrant it.  Side effects said
that approx. 40% of all people who are on it get sick to their stomach.  I
should think this would be the cause of the weight loss.  I am hoping I
won't ever have to go on it!

Signature

See my webpage:
http://mysite.verizon.net/juliebove/index.htm

ragebco@gmail.com - 20 Oct 2005 10:49 GMT
Thanks everyone for your input ... I suspect this needs a bit more
testing.
Thanks,

>> Has anyone heard of this medication?   A friend of mine just visited
>> the Mayo Clinic and was prescribed this to control her Type 2 ... I
[quoted text clipped - 6 lines]
>should think this would be the cause of the weight loss.  I am hoping I
>won't ever have to go on it!
Dave - 20 Oct 2005 16:21 GMT
Nausea went away in 2 days for me. None at all now.

>> Has anyone heard of this medication?   A friend of mine just visited
>> the Mayo Clinic and was prescribed this to control her Type 2 ... I
[quoted text clipped - 7 lines]
> should think this would be the cause of the weight loss.  I am hoping I
> won't ever have to go on it!
outsor@citynet.net - 20 Oct 2005 15:50 GMT
"Side effects said > that approx. 40% of all people who are on it get sick
to their stomach.  I > should think this would be the cause of the weight
loss.  I am hoping I > won't ever have to go on it!"

Only indirectly, byetta mimics glp-1 which is a hormone all of us produce.  
One of its actions is to blunt appetite in all people, it is one of the
feedback hormones that do this.  The blunting and gastric upset occur
because it has receptors in the brain as part of the feedback process.  
It works in diabetes because it has them in the pancreas to prompt insulin
output.
Wooly - 20 Oct 2005 17:28 GMT
>that approx. 40% of all people who are on it get sick to their stomach.  I
>should think this would be the cause of the weight loss.

Nausea, diarrhea, what's the difference?  I've been taking metformin
for five months now and I still can't schedule anything for the hours
between 8-10AM because I'm afraid to travel too far from a bathroom!

Who was it said "This too shall pass?"  I'm passing...and passing...

+++++++++++++

Reply to the list as I do not publish an email address to USENET.
This practice has cut my spam by more than 95%.  
Of course, I did have to abandon a perfectly good email account...
W. Baker - 20 Oct 2005 18:04 GMT
: >that approx. 40% of all people who are on it get sick to their stomach.  I
: >should think this would be the cause of the weight loss.

: Nausea, diarrhea, what's the difference?  I've been taking metformin
: for five months now and I still can't schedule anything for the hours
: between 8-10AM because I'm afraid to travel too far from a bathroom!

: Who was it said "This too shall pass?"  I'm passing...and passing...

Wooly,

If you are on the regular metformin, ask your doctor ot put you on the
extended release version and sill tke it on the csame schedule.  I had the
worst, constant, uncontrolled runs you can imagine and kind of lived on a
light dose of generic immodium to be able to go out of the house.  Once I
ws switched to the extended it went away like a harm.  

This is a YMMV issue, as others have not had the spectaclular success I
had, but it is, certainly , worth a try.  I no longer hve an imodium pill
in every pocket!

Wendy
Wooly - 20 Oct 2005 18:38 GMT
>If you are on the regular metformin, ask your doctor ot put you on the
>extended release version and sill tke it on the csame schedule.  I had the
>worst, constant, uncontrolled runs you can imagine and kind of lived on a
>light dose of generic immodium to be able to go out of the house.  Once I
>ws switched to the extended it went away like a harm.  

She put me on the extended release to start with.  I've played with
scheduling, spreading my total dose, buffering it with fat, with
carbs, with only veggies.  Seems that no matter what I do I've got
that same two-hour window reserved as "personal time".  Taking the
metformin with some sort of whole grain carb seems to reduce the
problem but hasn't totally, um, eliminated it.  A greens-only meal
with the metformin exacerbates things!

I have an appointment on Monday for a "how are things" sort of chat,
this is one of many things on my discussion list.  I belong to that
group of individuals who refuses to treat side effects of one pill
with yet another pill.  I'll drop the met and inject insuln before I
"treat" the metformin side effects with something.

Call me stubborn...

+++++++++++++

Reply to the list as I do not publish an email address to USENET.
This practice has cut my spam by more than 95%.  
Of course, I did have to abandon a perfectly good email account...
None Given - 20 Oct 2005 18:49 GMT
>> She put me on the extended release to start with.  I've played with
> scheduling, spreading my total dose, buffering it with fat, with
[quoted text clipped - 3 lines]
> problem but hasn't totally, um, eliminated it.  A greens-only meal
> with the metformin exacerbates things!

Try psyllium

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No Husband Has Ever Been Shot While Doing The Dishes

W. Baker - 20 Oct 2005 22:20 GMT
: >If you are on the regular metformin, ask your doctor ot put you on the
: >extended release version and sill tke it on the csame schedule.  I had the
: >worst, constant, uncontrolled runs you can imagine and kind of lived on a
: >light dose of generic immodium to be able to go out of the house.  Once I
: >ws switched to the extended it went away like a harm.  

: She put me on the extended release to start with.  I've played with
: scheduling, spreading my total dose, buffering it with fat, with
[quoted text clipped - 3 lines]
: problem but hasn't totally, um, eliminated it.  A greens-only meal
: with the metformin exacerbates things!

: I have an appointment on Monday for a "how are things" sort of chat,
: this is one of many things on my discussion list.  I belong to that
: group of individuals who refuses to treat side effects of one pill
: with yet another pill.  I'll drop the met and inject insuln before I
: "treat" the metformin side effects with something.

: Call me stubborn...

Some poeple say that using a highfiber psyllium product hslp.  It seems
counterintuitive that something people tak to "keep them regular"  would
also haelp cut down onthe runs, but many swear by this.  You might give it
a try.  Ir ws goin gto be my next thing if the extended release Metformin
had not worked.  My endo said it cna help.  YOu could also try kaopectate,
the old stand by.  It is made of kaolin clay and pectin, a gelatine like
product.found in fruit, for example, that makes jam jam, not just stewed
sweetened fruit.

 Not another pill, just some stuff from out in the world

Wendy
Jefferson - 21 Oct 2005 01:29 GMT
> Some poeple say that using a highfiber psyllium product hslp.  It seems
> counterintuitive that something people tak to "keep them regular"  would
> also haelp cut down onthe runs, but many swear by this.  

That what I thought 15 years ago, but I found it to be true especially
in the morning.  In addition, psyllium has good effects on the lipids.

Frank
Hi_Therre - 21 Oct 2005 11:54 GMT
>> Some poeple say that using a highfiber psyllium product hslp.  It seems
>> counterintuitive that something people tak to "keep them regular"  would
>> also haelp cut down onthe runs, but many swear by this.  
>
>That what I thought 15 years ago, but I found it to be true especially
>in the morning.  In addition, psyllium has good effects on the lipids.

It does???????????  I take a psyllium capsule each morning and two
days ago I found my cholesterol increased by about 50% in the past 6
months.  And that is with being on a statin.  So much for theory.
Jefferson - 22 Oct 2005 19:57 GMT
>>>Some poeple say that using a highfiber psyllium product hslp.  It seems
>>>counterintuitive that something people tak to "keep them regular"  would
[quoted text clipped - 6 lines]
> days ago I found my cholesterol increased by about 50% in the past 6
> months.  And that is with being on a statin.  So much for theory.

I have no idea what the volume of psyllium in capsules would be, but I
would imagine that it would be measured in milligrams. Most of the
studies on fibers that I have read mention a dose dependent effect
and the volume is in quite a few grams. Soluble fiber has a different
effect than insoluble (nondigestible) fiber.

"Results: Soluble fiber, 2–10 g/d, was associated with small but
significant decreases in total cholesterol ... and LDL cholesterol ... .
The effects on plasma lipids of soluble fiber from oat, psyllium, or
pectin were not significantly different. We were unable to compare
effects of guar because of the limited number of studies using 2–10 g/d.
Triacylglycerols and HDL cholesterol were not significantly influenced
by soluble fiber. Lipid changes were independent of study design,
treatment length, and background dietary fat content.

Conclusions: Various soluble fibers reduce total and LDL cholesterol by
similar amounts. The effect is small within the practical range of
intake. For example, 3 g soluble fiber from oats (3 servings of oatmeal,
28 g each) can decrease total and LDL cholesterol by <0.13 mmol/L.
Increasing soluble fiber can make only a small contribution to dietary
therapy to lower cholesterol." Source: Cholesterol-lowering effects of
dietary fiber: a meta-analysis -
http://www.ajcn.org/cgi/content/full/69/1/30

"Design: After a 2-wk dietary stabilization phase, 34 men with type 2
diabetes and mild-to-moderate hypercholesterolemia were randomly
assigned to receive 5.1 g psyllium or cellulose placebo twice daily for
8 wk. Serum lipid and glycemic indexes were evaluated biweekly on an
outpatient basis and at weeks 0 and 8 in a metabolic ward.

Results: In the metabolic ward, the psyllium group showed significant
improvements in glucose and lipid values compared with the placebo
group. Serum total and LDL-cholesterol concentrations were 8.9% (P <
0.05) and 13.0% (P = 0.07) lower, respectively, in the psyllium than in
the placebo group. All-day and postlunch postprandial glucose
concentrations were 11.0% (P < 0.05) and 19.2% (P < 0.01) lower in the
psyllium than in the placebo group. Both products were well tolerated,
with no serious adverse events related to treatment reported in either
group.

Conclusion: The addition of psyllium to a traditional diet for persons
with diabetes is safe, is well tolerated, and improves glycemic and
lipid control in men with type 2 diabetes and hypercholesterolemia."
Effects of psyllium on glucose and serum lipid responses in men with
type 2 diabetes and hypercholesterolemia -
http://www.ajcn.org/cgi/content/full/70/4/466

Also a study has shown a time-dependent effect.  The volume of a high
fiber diet was about 50 gram of fiber per day (table 3).  Results from
this study did not support the high fiber diet for lipid control (table 5).

"Conclusions: In subjects with type 2 diabetes, changes in serum
SCFAs in response to changes in carbohydrate and fiber intakes
took many months to occur, and the changes in serum acetate
were significantly related to the long-term adaptive changes in
blood lipids. ... Over the first 3 mo, the ratio of total to HDL
cholesterol increased significantly more with the LF diet than with the
MUFA diet, but this difference disappeared by 6 mo. Unexpectedly,
fasting triacylglycerol and cholesterol concentrations tended to rise
between 3 and 6 mo with the HF diet, and postprandial triacylglycerols
were significantly higher after 6 mo of the HF diet than after
6 mo of the LF diet (See table 5). ... Subjects were randomly assigned
to 1 of 3 treatments: ... ; high-fiber, low–glycemic index breakfast
cereal (HF diet); or ... .  The high-fiber cereals were Bran Buds with
Psyllium (Kellogg Co, Battle Creek, MI) and a prototype oat-loop cereal
enriched with psyllium." Source: Do colonic short-chain fatty acids
contribute to the long-term adaptation of blood lipids in subjects with
type 2 diabetes consuming a high-fiber diet? -
http://www.ajcn.org/cgi/reprint/75/6/1023.pdf

The only benefit that a high nondigestible fiber diet may contribute is
that it can be a prebiotic for the probiotic bacteria that cause
increases in the tissues of the colon (hypertrophic effect) which may
also produce more GLP-1 or GLP-2 [such as occur with longer life GLP-1
mimics such as Byetta or DPP IV inhibitors such as LAF237 (Vildagliptin)
that extend the life of incretin hormones (GLP-1, GLP-2; GIP)].

A scholar.google.com search for dietary+fiber+lipids+long+term resulted
in 5,570 finds - http://tinyurl.com/9n94k.  The first few pages give
enough results for further review.

Frank
None Given - 23 Oct 2005 00:17 GMT
> > It does???????????  I take a psyllium capsule each morning and two
> > days ago I found my cholesterol increased by about 50% in the past 6
> > months.  And that is with being on a statin.  So much for theory.
>
> I have no idea what the volume of psyllium in capsules would be, but I
> would imagine that it would be measured in milligrams. Most of the

I think one capsule has only half a gram in it.

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