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Medical Forum / Diseases and Disorders / Diabetes / August 2006Byetta Revisted
I have recently received a note from my insurance company that they need to talk with my Dr about the continued use of Byetta. I am wondering if this is becasue of the trouble of supply keeping up with demand. Overall the cost to me and the isurance company is less with byetta then before. > I have recently received a note from my insurance company that they need to > talk with my Dr about the continued use of Byetta. > > I am wondering if this is becasue of the trouble of supply keeping up with > demand. Overall the cost to me and the isurance company is less with byetta > then before. It may be because the ADA's most recent Treatment Guidelines relegated Byetta to the 3rd tier of drugs to be used and suggested it wasn't very effective. This gives insurers the green light to deny coverage for it. It's expensive, so the logic is obvious. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > It may be because the ADA's most recent Treatment Guidelines relegated > Byetta to the 3rd tier of drugs to be used and suggested it wasn't very [quoted text clipped - 7 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control Can you provide a link to that particular information where the ADA says its not effective? I'm curious to see where they get the idea. That goes completely against my own experience where Byetta has worked better than any of the four orals or insulin that I've used over time. It also seems to go against the experience of the people that I know that have used it and against the general experience of the online population that I'm familiar with. After all if it wasn't very effective then why was there a recent shortage of it and the company had to put another plant into production to keep up with demand? I thought maybe the links at the bottom of the note might have had it so I read through them (didn't find it) However I do have some observations about the Byetta page of the phlaunt site. It contains quite a bit of half information. The main thing I see about the page as I read is that it is written in a style that is intended to give the idea of objectivity but it clearly was written by someone with a disdain for Byetta and the intent was to steer people away from using it. It doesn't state anywhere whether the writer has tried Byetta or not but my guess is they have not. As far as the half information there is a slant that a lot of people get worse when they start taking Byetta. That seems to happen because you do not just add Byetta into your regimen. Almost always you have to come off some of the things you're taking when you start (I did). Anytime you change meds, especially a drastic change there will be an adjustment period. Instead of just cherry picking a statement or too from the Byetta blog where someone said their readings went up (almost always posted with the first week or two of starting) if you are a regular reader as I am you will find that a lot of those same people settle down and later report the best control that they've ever had. There are some of those at first, now long time users of Byetta with great control. It is true that a few people eventually could not get the control they wanted and went off Byetta but the same is true of every other medication and it seems to be a very, very small percentage. In regularly reading the Byetta blog for 9 months now I recall I think 2 or 3 people in that situation. Using three orals and trying to watch what I was doing I had an A1c that would run around 9 to 9.5. I added insulin to the orals and never got it less than 7.6. I dropped the insulin, dropped two of the orals, did NOT change eating habits or exercise at all, added Byetta and now have an A1c of 5.6. Just a little side note about my eating. When I started the insulin I went to a nutrionist to review if there was anything on the food side that could be done to help. She had me log everything I ate for a couple of weeks. I didn't change a thing and was completely honest about what I recorded. When she reviewed it and I quote "Well, I don't have any suggestions for you. I wouldn't change a thing." So the only variable there was the medications I was taking. Orals gave me A1c's of 9, insulin gave me 7.6 and Byetta gives me 5.6. So I hear 'Byetta is not effective' and I know immediately that there is something fishy going on. I'm a solid believer that Byetta is a terrific choice and one of the best developments in years to control diabetes. So I'm curious to read the information directly from the ADA for myself if possible if you could provide a source for that please. I searched the ADA site but couldn't find anything myself on what was implied but I did find a couple of articles that showed Byetta as giving good results (i.e. http://care.diabetesjournals.org/cgi/content/full/29/2/435?maxtoshow=&HITS=10&hi ts=10&RESULTFORMAT=&fulltext=byetta&andorexactfulltext=and&searchid=1&FIRSTINDEX =0&sortspec=relevance&resourcetype=HWCIT#F5 ) Warren and Paula Jo Merrill wrote in message <1156611086_6429@sp6iad.superfeed.net>... >Can you provide a link to that particular information where the ADA says its >not effective? I'm curious to see where they get the idea. That goes [quoted text clipped - 51 lines] >anything myself on what was implied but I did find a couple of articles that >showed Byetta as giving good results ( I have a suspicion that you can overwhelm Byetta with a hearty appetite, or make it look like a miracle drug if you are prudent. One of the CDE at one of my Hospitals reported a one lb per week weight loss over a three month period with accompanying improved ease of bG control. In contrast, my P.C.P. has not seen anywhere near that kind of good result in the patients he's given it to. I think that: http://www.medscape.com/viewprogram/5482 is rather interesting. ". . . .The first patient is a 62-year-old male who has had type 2 diabetes for 7 years. He's a retired pipe fitter, enjoys traveling and exotic fishing expeditions. He came into the study on metformin 850 mg 3 times a day. He tested his blood sugar once a day. He had hypertension and hyperlipidemia as additional medical issues. **!!!! He had never been in good glucose control. His lowest A1c event was about 7.3%. He had no concern about his weight. He had never attempted to diet a day in his life. He was worried about how additional therapy might impact his quality of life, especially with his travel. !!!!** He desired better glucose control and he was not at all anxious to deal with hypoglycemia, although weight was not much of a concern. His initial A1c was 8.2%. His weight was 227 pounds, and his mean fasting glucose was approximately 168 mg/dL. He was randomized to placebo. He had no problems learning the injections. When he came back at 30 weeks, not surprisingly, he did not improve his glucose control. I call him the perfect placebo patient because not only did he not change his glucose control, his weight was stable and his glucose levels were very stable. He entered the long-term extension trial, so he was placed on 10 mcg of exenatide (Byetta) after 4 weeks at 5 mcg. He had no nausea throughout any part of the trial. He denied any hypoglycemia. By 3 months he was feeling better. He did not have any problems with storage of his compound. He came back at 42 weeks. His hemoglobin A1c had dropped to 6.9%. This is approximately 3 months into the long-term extension. His weight came down 4 pounds. His mean fasting glucose came down about 30 mg/dL. He came back after 12 months and continued to feel better. He had no change in lifestyle. He wasn't attempting to diet. At this point, his A1c dropped to 5.3%. His weight came down to 211 pounds, and his mean fasting glucose continued to fall. He traveled to Argentina and ate more food than he probably should, and did come back at 1 point having gained a little bit of weight. But for the first time, he and his wife decided they were going to consciously follow a weight-reduction diet and he was able to take that and an additional 6 pounds off. At year 3 he now has a hemoglobin A1c of 5%, weight of 205 pounds, and mean fasting glucose of 110 mg/dL. So his A1c reduction over the 3-year period of time is 3.2%, weight loss of 22 pounds, and an excellent quality of life. . . ." IOW, a patient who is very much NOT interested in a "workayobuttoff" program went from HbA1c of 8.2 to HbA1c of 5.0 in three years. Regards Old Al More info about classes and pharmacotherapeutical treatment of hypertension and related medical conditions of high blood pressure: http://drugs-about.com/icd/i10-i15.html - Hypertension Diseases - Drugs-about.com - ICD-10 >> It may be because the ADA's most recent Treatment Guidelines relegated >> Byetta to the 3rd tier of drugs to be used and suggested it wasn't very [quoted text clipped - 3 lines] > Can you provide a link to that particular information where the ADA says its > not effective? http://care.diabetesjournals.org/cgi/content/full/29/8/1963 They don't exactly say it isn't effective, but they do relegate it to the third tier of treatment options after metformin and insulin and they say it is expensive and there is little experience with it. To see the discussion of Byetta, you'll need to look at Table 1. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control If you have to use insulin before byetta then that basically kills byetta. >>> It may be because the ADA's most recent Treatment Guidelines relegated >>> Byetta to the 3rd tier of drugs to be used and suggested it wasn't very [quoted text clipped - 17 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control > If you have to use insulin before byetta then that basically kills byetta. You mean as a product? From what my endo told me, the problem with Byetta is that it doesn't work well enough in most patients to justify the hassle. She said that after her initial enthusiasm, when her first Byetta patients were losing weight on it in the first months of taking it, she became decreasingly impressed with it because longer term it wasn't making enough of a change in their health status and the weight loss stopped quickly for quite a few of them. We hear from about the "miracle cure" folks here, who get the amazingly lower blood sugars and big weight loss, and there do seem to be a few of them, but if you read the Byetta blog, you'll see there are also great numbers of people who take Byetta who don't see their numbers go down and who don't lose weight. Surprising numbers of them. And the doctors are seeing them too. The other important point to remember is that before Byetta came onto the scene, doctors were convinced that people with Type 2 would do anything to avoid injections so they avoided prescribing insulin until people were on the brink of going blind. Suddenly, with Byetta they're seeing patients willingly injecting themselves with something that not only can give hypos, but makes a lot of them puke (which insulin does not!). So and the whole premise that they wouldn't inject is now out the window, and smart doctors are probably thinking, "Hmmm. If they will inject, how about they inject something that WILL lower their blood sugar very effectively instead of some experimental drug we don't know enough about!" It also doesn't help that Byetta costs more than twice what the expensive insulins cost. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >> Rick wrote: >> If you have to use insulin before byetta then that basically kills >> byetta. Rick, not at all. I used insulin for a full year before starting Byetta and stopping insulin. The Byetta not only works great but gave me much better results than insulin. > ..... but if you read the Byetta blog, you'll see there are also great > numbers of people who take Byetta who don't see their numbers go down and > who don't lose weight. Surprising numbers of them. And the doctors are > seeing them too. As a daily regular reader and contributor to the Byetta blog I see a few people like that but the phrase 'great numbers' is certainly an exageration. And once you start to regularly follow a number of those that report they are not having good you notice a lot of posts by them saying things like "I only had pancakes with syrup for breakfast and I can't understand why my numbers go so high" or my favorite is "I just can't pass up the ice cream shop every time I go by". Gee I wonder why Byetta doesn't seem to work for them? Now be honest and admit it. If those very same people were on orals they wouldn't seem to be working for them either or if you would care to REALLY be honest and admit it insulin isn't going to work for them either is it? It won't work but it has very little to do with the medicine. Its all about their total lack of self control and the "Hey, I take my sugar pills so I can eat anything I want" attitudes. It has almost nothing to do with Byetta itself. > Suddenly, with Byetta they're seeing patients willingly injecting > themselves with something that not only can give hypos, but makes a lot of > them puke (which insulin does not!). I realize that you've never used Byetta but I'm not sure either where you're getting your information. Byetta does not cause hypos anywhere near as much as orals and insulin do. In conjuction with other meds you still run the risk of hypos (mostly from the other meds) but using Byetta by itself drastically REDUCES the chance of a hypo. You can inject Byetta and then not eat and you will have no ill effects from doing that. Byetta is triggered as part of a first phase insulin response to consuming carbs. If you don't consume carbs it isn't triggered. I have accidentally done it myself, injecting and then I just got very busy and forgot to stop and eat. Didn't realize it until about four hours later when I started getting a bit hungry (very unusual to be hungry when using Byetta) and realized that it was because I hadn't had anything at all to eat. Can you say the same for almost any other orals or can you say the same for insulin? No way. The year that I used insulin I had to keep glucose tabs around to counter the hypos. I came close to passing out several times, one time I actually saw the black ring closing in around my vision. Only by putting my head down and chewing glucose tabs like crazy did I save myself (barely!!!). Since starting Byetta and dropping insulin I have not had a single glucose tab in 9 months now and have an A1c that is 5.6 at last check. Also on the 'puke' issue it does to some people but not nearly as many as you imply. A feeling of nausea (not puking, just nausea) is common in less than half of people who go on Byetta (44% in the clinical trials). Or another way to state that is MORE THAN HALF of people who use Byetta do NOT feel nausea, sickness or puking. > So and the whole premise that they wouldn't inject is now out the window, > and smart doctors are probably thinking, "Hmmm. If they will inject, how > about they inject something that WILL lower their blood sugar very > effectively instead of some experimental drug we don't know enough about!" How do you reconcile your statement with the fact that Byetta was recently in short supply because of a demand for the product that was outpacing supply? If there is any truth to the statement above then why is there a shortage? Wouldn't the docs just start refusing to write prescrips for Byetta and write them for insulin instead if they realize that they have their patients going down the wrong path? Of course they would but they're not doing it. If there was any truth to the statement above the docs have all the power to turn things that direction. Without my doc agreeing that Byetta is a better solution and writing me a prescrip then I would have no choice but to stop Byetta. Byetta is a prescription only med and requires the cooperation of a doctor for anyone to be on it. > It also doesn't help that Byetta costs more than twice what the expensive > insulins cost. I would gladly pay three or four times the cost of insulin to stay on Byetta and away from insulin. The year on insulin was one of the worst and most dangerous experiences I've ever had. Please understand that I have NO personal animosity toward you, only the ideas. Sorry but it seems the last while that any time there is a Byetta discussion that comes up you seem to take pot shots at it, in many cases giving out some mistaken ideas that just aren't truthful. You of course have a perfect right to say what you want but I will feel compelled to respond with corrections. Byetta has improved my life a LOT and I wish I could go back and use it years ago. I'm really concerned about some of the wear and tear that may have occured in my body from the difficult time that I had controlling my diabetes with the orals and insulins that through the years have been far from being as effective as Byetta has been for me. I find the idea about Byetta being new, untried, experimental and so you shouldn't take it somewhat amusing. So I assume then that in 1926 when insulin was discovered that your response would have been "It's new, its untried and experimental so people should avoid using it"? Hey, maybe someday there will be something discovered that was unforeseen with Byetta. But you know what, I'm not going to give up my 5.6 A1c and the chance at a long life that Byetta is giving me now and go back to my poorly controlled situation using insulin and orals because something MIGHT be discovered about Byetta. I KNOW what those years of poor control were doing to my body and what they would do to me if I went back to them. If someone isn't willing to try new things to improve their life then we would all be sitting in some dark cave (no fire) chewing on a piece of bark. I KNOW that my kids and grandkids have a much greater chance of having this same stinking disease. So you know what, not only am I seeing my own life improved right now by what I'm doing but if this works out I'm contributing to the day when they won't be chained to antiquated medicines that only try to counter the problems of the disease (orals and insulin) instead of going after the real causes of the problems like Byetta does. That as best I can quote is something my doc said "This is the first medicine that goes after the real root causes of the problems associated with diabetes". As much as you might feel its important that you, a non-user of Byetta, have the chance to post your ideas I feel it even more important that I as a actual Byetta user respond with my experiences and knowledge of Byetta. I find it somewhat horrifying to think that someone that could benefit greatly by using Byetta might be turned away it because they may only get the chance to read somewhat misguided information. >>..... but if you read the Byetta blog, you'll see there are also great >>numbers of people who take Byetta who don't see their numbers go down and >>who don't lose weight. Surprising numbers of them. And the doctors are >>seeing them too. (snipped) >>Suddenly, with Byetta they're seeing patients willingly injecting >>themselves with something that not only can give hypos, but makes a lot of [quoted text clipped - 7 lines] > not eat and you will have no ill effects from doing that. Byetta is > triggered as part of a first phase insulin response to consuming carbs. (snipped) It was only in the clinical trials with combined use of Byetta and sulphonylureas that patients became hypoglycemic. People on sulphonylureas often scale down their dose to avoid hypos. I must admit that I have some reservations about Byetta since it is not fully compatible with GLP-1 (approximately 60 %) and a DPP-IV inhibitor that partially prevents this enzyme from breaking down natural GLP-1 by extending GLP-1's life has more appeal to me. But even DDP-IV inhibitor are not as likely to be prescribed to people with A1c levels less than 7%. I suspect that a prebiotic-probiotic approach coupled with a DPP-IV inhibitor would increase the good glycemic effects of the latter especially for first phase insulin release and post-prandial BG levels. Frank What Jefferson said. Also continuing to increase the insulin levels in you body by injecting insulin is not good. There are a number of bad things that high levels of insulin can cause. The idea is to use you existing insulin and lose weight to boot; so you will need less of it. Byetta was marketed on that premis. A person can continue to take Actos or Advandia which are not cheap or switch to Byetta. If it works fine if not try something else. None of these drugs are a one stop cure all. My hbA1C was 5.2 3 months ago and I think that that is high. At that time I was on metaformin and actos. My most recient was on metaformin and byetta. I will find out tommorrow what the numbers are. By the way - no weight loss. The way I figure it if you are Type2 and on drugs your hbA1C should indicate that you are not diabetic. This is below 5. My goal is less then 5. >>>..... but if you read the Byetta blog, you'll see there are also great >>>numbers of people who take Byetta who don't see their numbers go down and [quoted text clipped - 31 lines] > > Frank >> I have recently received a note from my insurance company that they need to >> talk with my Dr about the continued use of Byetta. [quoted text clipped - 7 lines] >effective. This gives insurers the green light to deny coverage for it. >It's expensive, so the logic is obvious. A lot of users have posted in ASD and MHD that byetta helped them a lot. Ted Rosenberg is one of them. Could you explain why it is 3rd tier drug? DLife says it is the greatest thing since budweiser. I get confused easily. >>> I have recently received a note from my insurance company that they need >>> to >>> talk with my Dr about the continued use of Byetta. > A lot of users have posted in ASD and MHD that byetta helped them a > lot. Ted Rosenberg is one of them. Could you explain why it is 3rd > tier drug? DLife says it is the greatest thing since budweiser. I > get confused easily. I'm just guessing, but do you think it's because so many doctors are using it off-label to help people lose weight?  SignatureStan || On Sat, 26 Aug 2006 08:17:50 -0400, Jenny || <lottadata@hotmail.com> [quoted text clipped - 18 lines] || DLife says it is the greatest thing since || budweiser. Guess your opinion depends on what you think of Budweiser... :-) Signature-- "Knowledge is not only Power, it is Happiness, and being taught is the intellectual analog to being loved." -- Isaac Asimov http://www.obsessionthemovie.com http://www.americanpatrol.com/REFERENCE/isacrime.html http://home.swbell.net/bjtexas/SS/ I just had my check with the Dr. hba1c was 5.8 - up a little. Since I did not lose any weight and to avoid a fight with the insurance co. I am going back to Actos. I still have a few months supply of byetta so it will be a slow transition. > || On Sat, 26 Aug 2006 08:17:50 -0400, Jenny > || <lottadata@hotmail.com> [quoted text clipped - 20 lines] > > Guess your opinion depends on what you think of Budweiser... :-) BJ in Texas wrote in message ... >>Guess your opinion depends on what you think of Budweiser... :-) Once upon a time, when the world was young, my wife bought a used piano. She did all the shopping and negotiating, my job was to move it from the folks selling it to our living room. I rented a trailer and recruited a bunch of neighbors to haul it over. My wife made pizza and I went out and bought a six-pack each of most of the popular and premium beers available in our town. I set all the beers out, all in a row, (when the job was done) and let the guys pick their favorites They drank from left to right. Regards Old Al > They drank from left to right. ROFL! So nice to see people maintaining their cultural norms : ) Bet the Brits would do it right-to-left :D Nicky. SignatureA1c 10.5/5.3/<6 T2 DX 05/2004 No Metformin, 100ug Thyroxine 95/72/72Kg |
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