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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

Living Longer with Byetta

August 11th, 2008 · 26 Comments

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The diabetes drug Byetta can help us control our blood glucose and lose weight. That’s huge — and just the beginning of the story.

Full disclosure: I own 100 shares of stock in Amylin, the company that developed Byetta.

About a year ago, after the Scientific Sessions of the American Diabetes Association in Chicago, I reported here how Byetta can reduce our risk of heart attacks and strokes. These are the most common and deadly complications of diabetes.

Now a study presented at the ADA’s recent Scientific Sessions in San Francisco indicates that the reduced risk to our hearts may lead to previously unheard of benefits. Taking Byetta can lower our chance of dying compared with other diabetes drugs. The Times says that the chance of dying while taking Byetta is about 75 percent lower than on the other drugs.
While I attended these Scientific Sessions, I admit that I missed the big news then. But so did almost everyone else. It wasn’t until The New York Times broke the story last Tuesday that it attracted public notice.

Other than The Times, the story doesn’t seem to be in print. Times reporter Alex Berenson picked it up in an oral presentation at the ADA on the ACCORD study.

The presentation was a big and pleasant surprise to Amylin and to Eli Lilly, which markets Byetta for Amylin. “I was sitting in the audience, and my jaw just dropped,” Dr. James Malone of Lily told The Times.

ACCORD stands for Action to Control Cardiovascular Risk in Diabetes. The New England Journal of Medicine online. But nowhere does it include the report on reduced death risk teased out by the drug that the study participants took.

This study included people with diabetes taking all the major classes of diabetes drugs. Some used insulin, others used the sulfonylureas, metformin, the thiazolidinediones, and a few were on Byetta. Only 826 of the 10,251 people in the trial were on Byetta.

That’s a small subset, and the people taking Byetta could be different in some important ways from the others in the trial. For example, they could have been healthier from the start.

“We don’t know whether it’s the drug or the healthy participants,” Dr. Michael Miller told The Times. He is a professor of biostatistics at Wake Forest University and the study’s lead statistician.

The big question now is how and when Amylin and Lilly will try to confirm the exciting finding of Byetta’s reduced risk of death. But the companies may never do the studies on Byetta itself, because they are looking forward to the once-weekly version, called exenatide LAR. They hope to have that version of the drug on the market next year. Since it promises to be an even greater success than Byetta with those of us who have diabetes, my guess is that Amylin and Lilly will do the life-extension testing on the once-weekly version.

Byetta would have been an even greater success if there were not some concern about pancreatitis and the fears of nausea. The Times article mentioned these issues, and people with diabetes are concerned about them. So I raised them with Dr. Joe Prendergast, an endocrinologist in Palo Alto, California, who has prescribed Byetta to hundreds of his patients ever since it first became available in Byetta’s clinical trials.

Last October I covered the pancreatitis issue here — as a non-issue. Dr. Prendergast confirms my report.

“With pancreatitis the numbers were seemingly less than seen the general population,” Dr. Prendergast told me. “I couldn’t see how they could ascribe it to that. It’s small enough that it’s unlikely to be associated in any way.”

Nausea is more real. But I know from my experience on Byetta that nausea isn’t inevitable and reported here the many strategies different people use to deal with it.

“If nausea occurs, we do use medications now,” Dr. Prendergast says. “We use Phenergan (promethazine), which is an easy drug. It is just an antihistamine with some anti-nausea capabilities. It’s maybe 50 years old.

“If there is any nausea at all, we just say to take it just once a day, just before bedtime, because you probably won’t be nauseous all night long. Don’t do the second shot. I tell them that I don’t care if it takes three months or six, we will just hang in there, because we know that everybody gets over the nausea eventually and we want you to as well. We are not going to hurry it.”

He says that his patients get the results they want — lower blood glucose levels and weight loss. “But the most exciting thing is that we see all the complications diminish.”

He says that several opthamologists told him about the surprising good results that Byetta had on the retinopathy of their patients. “With that I was emboldened to try it on a gentleman who already had a lot of retinal hemorrhage and was losing his sight. I said, ‘Let us try small amounts of Byetta and see what it does.’ And the reports started coming back saying that he was stable. All of a sudden after six or nine months his vision was improving.”

It reversed his retinopathy? “He’s not seeing like when he was 16, but it reversed a little. And we weren’t doing anything else except Byetta.”

So far we have only preliminary reports on Byetta’s benefits for controlling complications. But the evidence of how it might help our hearts, our eyes, and even living longer lives keeps on coming.

This is a mirror of one of my articles that was originally published on Health Central.

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Posted in: Diabetes Developments, Diabetes Medication

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26 responses so far ↓

  • 1 Steve Bukosky // Feb 18, 2009 at 3:34 pm

    I’ve been diagnosed for eleven years now and began insulin (Levemir) when I joined a study a little more than a year ago. My weight is my problem and tomorrow I’m seeing my doctor and asking about Byetta. After having to increase my pants size once while on Levemir, I need to do something. I hope this is it. Three years ago I lost 60 pounds and dropped most of my oral medication. I gained it back with a vengeance. The spirit is willing but the flesh is weak.

  • 2 David Mendosa // Feb 18, 2009 at 4:03 pm

    Dear Steve,

    Your flesh will be stronger on Byetta! This wonderful new medication really helps us to lose weight. On the other hand insulin is well known for its tendency to make us gain weight.

    Best regards,

    David

  • 3 John McClure // Feb 21, 2009 at 1:51 pm

    For those who have difficulty losing weight on the standard American Diet (SAD), the definitive, intensely researched book that finally explains the surge in obesity and diabetes in the Western world had now been written. “Good calories – Bad calories” by Gary Taubes shows how American medical orthodoxy and their dangerous food pyramid is responsible. If you love life and want
    more of it – READ THIS BOOK!!!

  • 4 David Mendosa // Feb 21, 2009 at 4:38 pm

    Dear John,

    I couldn’t agree more! That book changed my life.

    Best regards,

    David

  • 5 Steve Bukosky // Feb 28, 2009 at 9:06 am

    I had to convince my internist, to prescribe it. Then my insurance wouldn’t cover it and over a week later they still are going rounds. Never mind that they have a big wellness program and base my premiums on various health markers. In my case I pay extra because of my fasting blood glucose and weight. Now, with some hope to improve upon it, they balk. Nothing is stopping me from paying for it myself though. The foggy messages from one’s health insurance are frustrating however.

  • 6 Sarah P. // Mar 5, 2009 at 7:32 am

    Hi David,
    I ‘ve been on Byetta for about 6 months. I didn’t have much problem with nausea or other side effects. I didn’t lost much weight to start with but then started Weight Watchers in January (my 3rd or 4th attempt on that diet). It’s going really well, thanks to the Byetta. I’ve lost 18 pounds in 7 weeks. Still have a long way to go but what I can’t get over is that I no longer feel like I’m constantly battling the food/hunger. I’m able to concentrate on finally figuring out what/when to eat what my body needs most without having to fight with my demons that only want to eat sugary/fatty foods.

    Your book has been an inspiration to me. Thanks!

  • 7 David Mendosa // Mar 5, 2009 at 9:44 am

    Dear Sarah,

    That’s so good to hear! I am so glad that I helped. Thanks for writing.

    David

  • 8 chad nyakairu // Mar 18, 2009 at 2:42 am

    I am not over weight only 65kgs.Is then advisable to take Byetta?I am not controlling properly my glucose levels.I am diabetic for 5 years now.

  • 9 David Mendosa // Mar 18, 2009 at 8:22 am

    Dear Chad,

    Yes, indeed, Byetta is PRIMARILY for blood glucose control. The weight loss is only a side benefit for those who need it.

    Best regards,

    David

  • 10 Donnie // Oct 23, 2009 at 11:01 am

    What is the best approach for a skinny diabetic. I controled my type 2 with herbs and diet until going to a dr. for a back problem. After telling him I could not take any type of steroid because of being a diabetic. He gave me a shot of prednisone which sent my blood sugar to 600+. I had to be put on insulin and have not been able to get off of it since.I lost from my 140lb normal to 123 in 2 weeks. Can’t gain it back. Very hard to keep regulated Blood sugar

  • 11 David Mendosa // Oct 23, 2009 at 11:20 am

    Dear Donnie,

    What a strange medicine prednisone is! While it is indispensable for treating many conditions, it raises our blood glucose tremendously. It can even cause diabetes.

    Yes, it is hard to control blood glusose with insulin. Another strange medicine because it can be essential too. You probably need a good doctor, but start with the books “Think Like a Pancreas” and “Using Insulin.”

    Best regards,

    David

  • 12 K V Rao // Nov 12, 2009 at 2:33 am

    I have been recently put on Januvia 100 od in addition to my regular concoction of glyclazide 80mg bd and metformin 500 bd. I was earlier put on pioglitazone 15mg bd, but as I developed leg edema, I was taken off that. But, after reading your articles, I have a feeling that I should discuss with my doctor to try bydetta, What do you suggest, as I am not having any particular problem with my present medication. I am 58 years of age and weigh 62 kg at 5′ 6″ and am on medicines for past 13 years.

    Your information is wonderful and only today I accidentally chanced upon your website. Many thanks for all the info.

  • 13 David Mendosa // Nov 12, 2009 at 8:44 am

    Dear KV,
    If you could get off the gliclazide, which is a sulfonylurea, it could be a good idea. All sulfonylurea drugs have the potential of giving you hypos. They also have the potential of burning out the beta cells in the pancreas, although that still seems to be in dispute. Metformin is a fine drug, although I see that the dose you are taking is a very low one that isn’t doing much for you. Januvia doesn’t do much, but the company that markets it, Merck, is pushing it hard to doctors. It is generally acceptable to prescribe three different medications to people with diabetes, but some doctors don’t like to prescribe that many because of the greater number of possible interactions, and I agree. Your BMI is 19.9 so your weight is fine. Great job, particularly considering that another disadvantage of sulfonylureas is that they make us gain weight. Metformin and Januvia don’t, and Byetta can help some people lose weight. The other consideration is your blood glucose control as measured by your A1C. If it is below 6.0, you are doing so well that your doctor would probably not want you to make any switch. But since your doctor just put you on Januvia, my guess is that your level is too high. In which case stopping the Januvia and the sulfonylurea, adding the Byetta and/or increasing the dose of metformin might be a good thing to discuss with her or him.

    Best regards,

    David

  • 14 K V Rao // Nov 12, 2009 at 8:38 pm

    Dear Mr Mendosa,
    my blood sugar levels are 90/120 after the Januvia addition. Previously they were never that better, mostly around 120/160 with gliclazide, metformin and pioglitazone. I briefly experimented with insulin but could not get as good control as with oral medication. My Aic levels are 6.8 when tested a month ago, that is before Januvia addition. Anyway, I shall discuss the matter with my physician.

    Regards

  • 15 rafael del fierro // Apr 19, 2011 at 10:11 am

    David,

    I take byetta 20mcg, is it ok to use the nano needle,
    do you recommend victoza in addition to byetta?

    Regards,

    Rafael del fierro

  • 16 David Mendosa // Apr 19, 2011 at 11:44 am

    Dear Rafael,

    These are both questions for you to ask your doctor. But I can’t imagine how you would get the Byetta into a different injection device and have never heard of using both Victoza and Byetta.

    David

  • 17 Deborah // Jun 22, 2011 at 6:51 pm

    David – I just started Byetta last week. So far, no problems. I am confused about whether to continue taking my fish oil, CoQ10, multivitamin after the meals when I had the Byetta. I take my blood pressure & statin at bedtime which is 9 pm and hope that is ok since it is approximately 3 & half hours after the Byetta. Where do I find the answers about this sort of thing. Thanks!

  • 18 David Mendosa // Jun 22, 2011 at 9:22 pm

    Dear Deborah,

    I am pretty sure there is on relationship between those medications and Byetta. Except for those statins, which as I have written I have many questions about, you would do well to continue them.

    David

  • 19 Debbie // Jun 23, 2011 at 9:15 am

    Do you think I should take the supplements after the meal with which there was no Byetta shot or does it matter as far as the absorbtion rate with them? I did not want to take the statin. My Dr. let me try to get the numbers down without it but they were horrible so he insisted. Maybe if I can lose weight the numbers will come down & I can get off it!

  • 20 David Mendosa // Jun 23, 2011 at 12:31 pm

    Dear Debbie,

    While Byetta probably wouldn’t change the rate of absorption of the supplements, it does affect a couple of things. So play it safe and take them with your lunch.

    David

  • 21 Debbie // Jun 28, 2011 at 1:19 pm

    David – I also usually drink some green food in the morning. Do I need to change the timing on this, too? I have ordered your book so maybe the answers to many of my questions are in it!

  • 22 David Mendosa // Jun 28, 2011 at 6:45 pm

    Dear Debbie,

    The only timing with Byetta that matters is that you have to take it within 60 minutes of starting your meal.

    David

  • 23 Debbie // Jul 1, 2011 at 7:29 am

    David – I guess what I’m really trying to figure out is this – - do I need to take all my supplements at lunch time because of taking Byetta before breakfast and dinner? I want to get the most out of my supplements as well as the most out of the Byetta so don’t want anything to interfere with each other. Also, I always put a tablespoon of vinegar in with the green food so does that need to be at either lunch or bedtime now instead of breakfast? Sorry for so many questions but my Dr. is no help with all this.

  • 24 David Mendosa // Jul 2, 2011 at 12:00 pm

    Dear Debbie,

    What a great question! While I don’t think that Byetta would interact with your supplements, I don’t know. And I honestly don’t think that anyone knows. Still, I would guess that they wouldn’t. One caveat that I can think of is that B vitamins and multivitamins that contain them are better taken with breakfast or lunch than with dinner, because taking them late in the day can interfere with sleep.

  • 25 Louise Dorich // Jul 4, 2012 at 7:46 am

    Dear David,
    What a pleasure it was for me to discover your Website and all the information concerning Byetta. Before being on Byetta, I was taking 150 U a day of 50-50 novolin and 30 U of novorapid my weight was going up and up and of course the doctor wasn’t happy with the results, I felt that I was dying slowly but surely. In January 2012 I had the chance to see a diabetes specialist and he explained to me that my DNA was also responsible for my diabetes problem and he offered to me 2 options Byetta or gastric bypass. Of course I chose Byetta, well I am happy to say that Byetta did it! Living in Canada my index numbers are not the same as yours but I am happy to say that I am almost normal, the point is I am still taking 90 U a day of Humulin, I just wish that I would lose weight but only 6 pounds is really not enough. Also I have a problem that I did not see written anyware, constipation….and very serious since taking Byetta, I have to take once a week a Asepta limonade because nothing else will do, 6 or 7 days of constipation is scary. I eat fruits and vegs but it only puts pressure on my stomach…(i don’t know how to explain this) could it be Byetta (hope not). Do you have a trick for this and in your experience is Byetta a cause for constipation! Tomorrow the 5th of July I am seeing my specialist and I will ask him about taking Byetta 3 times a day to lose weight. I am ordering your book also, thank you so much for all of your articles on this medication, it gave me the confidence I needed to use it without being scared of the complications. Excuse my English I usually speak and write in french, I sincerely hope that you have no problem reading me. Louise

  • 26 David Mendosa // Jul 4, 2012 at 8:18 am

    Dear Louise,

    I am glad that I can help you. And I have three comments:

    1. Your slow weight loss is probably because you are also using insulin, which is well know for causing weight gain. It doesn’t have to, however. The exact timing in relation to when you eat and the amount in relation to what you eat, is important. Please discuss this with your doctor or nurse.

    2. Constipation is probably not a side effect of your taking Byetta. I have to say “probably” because everyone is different. But constipation can have many causes. My guess is that when you went on Byetta your diet changed. Maybe you are drinking less water, and everyone thinks that drinking too little water causes constipation. Maybe you are now following a very low-carb diet, where you actually need to use more salt in order to prevent constipation. Or it could have other causes.

    3. Byetta is a wonderful medication. But since you are considering taking it three times a day, you also need to consider taking Bydureon instead. You take this new medication as one injection PER WEEK, and it is the same medication as the twice-daily Byetta.

    David

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