[Diabetes-talk] Byetta.

[Michael Park]

Hi there.

I meant to send this one off in response to one of the emails in which

someone wrote that they are on Byetta, but due to being very busy, I

could not get round to it as soon as I would have liked to.

I think I have the spelling right on this one.

I first heard about Byetta, alias lizzard spit back in 2010 at an

educational meeting for diabetics where a leading diabetologist in our

country, talked about Byetta.

The facts concerning Byetta are, as will be seen in more detail later,

that it is only helpful for type II diabetics. If you are on insulin,

whether type II or type I, Byetta is not the solution for you, since it

is presupposed that if you go onto Byetta, your Pancreas is still

producing enough insulin for the body and that the problem you have is

that body tissue is under utilising the insulin.

The reason why I refer to Byetta as Lizzard Spit is the fact that

Byetta actually comes from certain hormones found in the saliva of the

Geelamonster, which I believe, is a carnivourous lizzard with a vicious

and even poisonous bite. The lizzard, I believe, is found in Mexico.

What interested researchers, is the fact that the Geelamonster

apparently eats once every six months, and it is while researching this

aspect of the life of the Geelamonster, that they stumbled upon

something called Glucagon-like Peptide.

Glucagon-like peptide is something which works just like Glucagon

itself, in that it causes blood glucose levels to rise, and in the same

way as you have glucagon and insulin working against each other as a

regulatory mechanism for the control of blood glucose levels,

Glucagon-like peptide works against another hormone which I will call,

for the sake of brevity, DPP4, to also help regulate blood glucose

levels.

Although these substances are found in the saliva of the Geela Monster,

I believe that most of the products are now manufactured synthetically.

I must mention by way of an interlude, that I took Physiology as one of

my subjects in Grade 12 and much of my understanding of what I have

shared and what I am about to share, is based on, and derived from,

what I have learnt, as well as being modified by what I have read up on

medical sites on the internet from time to time and information I have

received from my doctor from time to time, and information given to me

by my nurse care-giver from time to time.

When I was at school, we were basically taught that when a person eats,

the food is digested into an absorbable form in the stomach and it is

then absorbed when it passes into the small intestine. Nothing could be

further from the truth. Food is digested in the stomach, that much is

true, but a lot of digestion also takes place in the small intestine.

Bile breaks fats down and ultimately helps to convert them into blood

glucose, while much of the digestion and even the body's blood glucose

regulatory mechanism is also affected by the state of health of certain

friendly bacteria which naturally reside in the small intestine. These

friendly bacteria are also known as probiotics and one of the reasons

why diabetics may be prone to a greater amount of infections, could be

due to these bacteria being rendered replete through antibiotic

treatment and even other infections that attack and destroy these

bacteria.

So for instance, bacteria known as Lactobacilli, are responsible for

the conversion of milk sugar (Lactose) into lactic acid rather than

into glucose and this lactic acid is then discarded as a waste product.

For some strange reason, and that is assuming for the moment that we

are not diabetic, we actually have to take in more sugar than we need,

to absorb the right amount of sugar, and as I understand it, and I am

subject to correction, the excess sugar acts as nutrition for the

friendly bacteria to be able to play their part in maintaining our

immune systems. The case of the Lactobacilli, I mentioned earlier, is a

case in point. It is for these reasons that I believe that every

diabetic should consider going onto some probiotic as part of the

treatment and if the thought of another tablet does not appeal to you,

yoghutt is perhaps the best natural source of probiotic on the market.

You should preferably consider the ones which are marked as having live

culture in them, and the best product, though it is quite vile tasting,

is an unflavoured yoghutt known as Bulgarian yoghutt.

You should however, when you do take probiotics, keep an eye on blood

sugar levels. I don't say that this is the case for everybody, but in

my case, certainly, probiotics seem to lower blood sugar. I suspect

that this may b the case in other diabetics as well, hence the fact

that my suggestion of including probiotics as part of the treatment,

should be undertaken advisably and with great caution.

Precautions should be taken preferably against going hypo, or at least,

you should make sure that where ever you go, first aid is available

should you go hypo. The benefits of probiotics outweigh the risks

attaching to them in my view, and that is why these should be

considered favourably.

What intreagues me though, is the fact that here you cannot get

antibiotics over the counter, but probiotics are readily available,

notwithstanding the effect that they might have on the blood sugars of

diabetics. The worst part of the deal is the fact that not every

chemist in this part of the world, has the necessary integrity to sell

probiotics to the public responsibly, but that is a subject for another

day. Fortunately, my nurse care-giver's chemist is one of the honest

ones in the country and one whom I am also recommending to other

diabetics to whom I am also forwarding this post.

This is a bit of background to show that I believe that Byetta is only

one of a number of mechanisms in the human body, that actually

regulates blood glucose levels and this is also the way in which what I

have to share here, must be understood. I can now proceed with a

discussion of Byetta itself.

When a non-diabetic person eats, their blood glucose levels rise rather

suddenly, but they drop equally suddenly. When, however, a diabetic

eats, the blood glucose levels, interestingly enough, may have a more

gradual rise, but often, they don't drop down again. Instead, they

continue to rise.

The other problem that we have as diabetics, and I certainly have that

problem myself, is that we cannot stop eating. There are a number of

technical reasons for this that I won't dwell on here, but suffice it

to say that we continue to eat and eat, and glucos levels continue to

rise and rise and, in my case, I have often found that even if I stop

eating, the blood glucose levels do not always drop and it happens that

if I have a binge for instance, that I can have high blood glucose

levels for as much as a few days after the event. Blood glucose levels

can also be high and unstable. If one is inclined towards high and/or

unstable blood sugars, even though one is sticking to the diet, this is

the time when the biocheneticist comes into play in order to prescribe

a proper exercise routine tou help counteract excessively high blood

sugars and where, for a host of technical reasons I won't dwell on

here, one might give probiotics a favourable look and if your pankreas

is still producing adequate insulin, your doctor might consider moving

you onto Byetta rather than say, Medformin, to medicate your condition.

As I said, what happens in diabetics is that there is not the same

characteristic drop in blood sugars as there could be in non-diabetics.

The reason for this may be that a person gets hungry, and the normal

glucagon-like peptide is produced in the small intestine. The person

may eat but then the production of DPP4, which occurs, when you are

full, does not materialise and this is a plausible explanation for the

ongoing increase in blood sugar levels.

I first heard about Byetta in 2010 and when this person addressed us,

we were told that Byetta could amount to an actual cure for diabetes.

Apparently, at that time, Byetta was undergoing advanced trials, but it

was and now still is apparent, that Byetta would be a very expensive

solution for diabetes management. This is certainly the case in this

country.

At that same talk we were also told about trials conducted by

diabetologists in Russia which would be a viable alternative to Byetta

and that this alternative would be a cheaper alternative to Byetta and

that it was hoped that this would be as effective as Byetta. This

alternative involves the laproscopic inplant of a capsule into the wall

of the small intestine. The capsule apparently has a mechanism which

regulates DPP4 and Glucagon-like Peptide.

I was very interested in participating in this trial should it come to

South Africa and although I am on public health care where Byetta is

simply out of the question, I asked one of the diabetologists I see, to

put my name down for the trial, should it come to South Africa.

I have been able to monitor someone who is on Byetta and personally, I

have turned from being very interested in Byetta and Byetta-like

solutions, to being highly sceptical of them. I have taken my name off

the list of volunteers for the Russian experiment on account of what I

observed about Byetta, since the apparent risks attendant on Byetta and

Byetta-related solutions are in my considered oppinion, not worth

taking.

I must at this point stress that there are a lot of good things that

Byetta does, since I do believe that it would help many type II

diabetics. For one, and I am not going to dwell on this in detail, it

directly helps increase the Alpha cells of the Islands of Langerhans

and indirectly contributes to the increase of the Beta cells in the

Islands of Langerhans, situated in the Pancreas, and in so doing, helps

in a way other than I mentioned earlier, bolster the body's sugar

control mechanism. I must stress that I have no doubt that Byetta will

help many diabetics, but having observed someone who is on Byetta, I

have been less than impressed at what I saw.

When this person went onto Byetta back in 2010, she was as sick as a

dog for weeks on end before she could even begin to benefit from the

Byetta. She was warned that being as sick as a dog could initially be

one of the side effects of Byetta, but if these effects persist, they

would have to call the trial a day. She did, however pull through with

the trials, but has repeatedly had to be taken off and put back on to

the stuff again.

At the time of her going onto Byetta, she was recording blood sugars

anywhere between 270 and 360 mg/dl (which translates to between 15 and

20 MMol/l). She recorded those kinds of readings even though her body

was producing the right amounts of insulin, but it was a case of the

various tissue not utilising the glucose in the blood stream properly.

The result was that her Alpha and Beta cells actually increased and the

Byetta lowered the blood sugar to the lower 130's for most of the time.

In our measurements, this would translate into averages of between 7

and 7.5 which although OK by general diabetes management norms, does

not equivocate to normal blood sugars.

On the other hand, I try and am successful in maintaining my sugar

averages at 117 or lower, which translates into 6.5 or lower, that is,

if I stick to my diet, and I must admit, I do cheat sometimes and get

higher than acceptable sugars. I have arrived at these figures for my

personal norms through copious testing and identifying the various

patterns in my blood glucose movements, and for that reason too, I

don't think that I would benefit from Byetta or a Byetta-related

solution.

As an aside, and probably most of you do this already, I can only

recommend copious testing in order to determine what your proper blood

glucose norms should be, since the general norm is only a starting

point for glucose monitoring. If you use the general norm only, as your

exclusive norm, you will be six foot under before you know it.

Given the fact that I am a brittle diabetic, and I am more brittle than

she is, and yet I am able to manage my sugars at levels very close to

normal through tablets, diet and exercise, but I hope that the tablets

will fall out of the equasion one day, I have come to the conclusion

that as a diabetic, I must be content to wait for a bigger breakthrough

than Byetta or Byetta-like solutions. I am sure that if I had the

funds, I would qualify for Byetta, since recent tests have shown that

my pancreas  is producing adequate insulin but that my problem,

apparently, is the utilisation of that insulin, but based on what I

have seen about it, "no thanks" for me.

The other problem with Byetta is that if you contract certain

infections at least, the Byetta treatment has to stop till the

infection is sorted out and then you have to go back onto Byetta again.

I can well imagine that in some instances, the sickness will also come

back with the re-introduction of the Byetta, and I have, in taking this

consideration into account as well, decided that Byetta is not the

answer for me.

As to the frequency of injections, I would imagine that there would be

different strength Byettas as there are different types of insulins.

The person I referred to earlier in this post, injects herself twice a

day.

A final interesting observation on the matter of Byetta, is the fact

that there is a thinking in medical circles that a type of diabetes,

known as type III, should be recognised. From what I have been able to

gather, type III, unlike type I and type II, would be related to the

DPP4/GLP thing and not to the question of insulin.

-- 
Michael Park.
I am not an expert, because "ex" means "has been" and "spert" is "a drip under pressure".