Battling Diabetes

Byetta is in a class of diabetic medications not mentioned in the August 11, Battling Diabetes post, Oral Diabetic Meds Unraveled.

Byetta (the trade name for exenatide) is an incretin mimetic. Incretin mimetics work by mimicking the body’s natural incretin hormones which lower blood sugar. Incretin hormones or gut hormones are released in response to food and act by stimulating insulin and inhibiting glucagon.

Byetta:

• Assists pancreatic response to release more insulin as needed to digest food
• Prevents the pancreas from giving out glucagon which causes the liver to release glucose into the blood stream when it is not needed.
• Delays gastric emptying which makes you feel full longer.

Approved June 1, 2005 by the FDA and manufactured and marketed by Amylin and Eli Lily and Company, Byetta is considered an adjuvant therapy for Type II diabetics who do not have control with metformin, and or sulfonylureas and or thiazolinediones. Adjuvant therapy is treatment given in addition to primary therapy.

Byetta is a synthetic hormone first discovered in the saliva of the gila monster (lizard).

Basic Byetta use information:

Byetta is given as an injection, similar to insulin and comes in pre filled pens which are stored in the refrigerator. Needles do not come with Byetta.

Byetta is used one hour before eating a meal, and us usually injected twice a day at the same time each day, before the morning and evening meal. Byetta is NOT used after eating a meal. Dosing pens are in 5 mcg or 10 mcg. You can download a user manual for the 5 mcg pen or the 10 mcg pen.

The makers of Byetta are currently testing a long lasting injectable for use once a week. The current patent for Byetta expires in 2013

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• Pharmacology for diabetics has come a long way. Here’s a quick primer on the oral prescription products that are available. Note that Type II diabetics are prescribed oral medications as these agents are for people who don’t make enough insulin or are in most cases insulin resistant. The categories are described in layman’s terms and this is not an inclusive list. For more indepth information including adverse drug issues see the resources.

Classifications of Oral Agents:

Alpha-glucosidase Inhibitors:This type of drug delays the absorption of carbohydrates. They are generally taken with meals.

• Miglitol (Glyset)

• Acarbose (Precose)

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June 12, 2008, Reuters Health: Diabetic Weight Loss Plan Yields Long Term Success. One year later. The findings of the follow up of the Joslin Diabetes Center, Why Wait? program show that the participants of the 12-week program for Type 2 diabetics resulted in an average weight loss of 24.6 pounds and good control of blood glucose levels and blood pressure.

What is Why Wait?

The 12-week program involves exercise, dietary changes, education, counseling and adjustment of diabetes medications. Participants meet weekly and the program is insurance reimbursable. There is a monthly support session fee of $25 out of pocket.

Program components per the Joslin Why Wait? site:

• Intensive and interactive medication adjustments
• Structured modified dietary intervention
• Graded, balanced and individualized exercise intervention
• Cognitive behavioral intervention
• Group education

The dietary component portion of the Joslin Why Wait? program includes meal replacement shakes for breakfast and lunch. Snacks between meals. Dinners are from 14 menu selections from the Joslin Nutrition Guidelines. Nutritional breakdown of the meals are about 40% carbohydrate, 30% fat and 30% protein.

Additional Joslin weight notes per Why Wait? site:

• A modest weight loss of one pound every one to two weeks is advised.
• Reducing daily calories should be by 250 to 500 calories; total daily calories should not be less than 1,000 to 1,200 for women and 1,200 to 1,600 for men.
• Weight loss is different for each person and should be continued until a person reaches a target body mass index, or BMI.

Calculating target body mass index or BMI:

• Fit Watch
• Target Health
  

The exercise component portion of the Joslin Why Wait? program recommends ” A minimum of 150 to 175 minutes of moderate intensity physical activity is recommended. A target of 60 to 90 minutes most days of the week is encouraged.”

The medication component portion includes working with a diabetologist to reduce or eliminate medications that interfere with weight loss. It is includes more frequent glucose monitoring. Medications are adjusted weekly based on your personal results.

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