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RE: [IPk] Byetta / Lantus regime question



Nick,

Your friend needs to get very far away from that GP, quickly!!! I would 
advise her to run for the hills. Your friend's GP is playing fast and loose 
with her health.

Byetta (exenatide) is NOT approved for use in type 1s!!! It has not been 
shown in any proper studies to have positive effects on type 1s' glycemic 
control and it is very much off-label use for your friend's GP to be 
recommending it to her. In most cases Byetta use should not be overseen by a 
GP anyway, it's a drug better left to the consultants to prescribe and sharp 
DSNs to titrate as the patient selection criteria would require the 
specialist knowledge of a consultant in almost all cases.

How often is your friend's A1C being measured? How many times per day is she 
checking her blood glucose? I would not be surprised if she has been advised 
that 1 A1C a year is enough and 3 glucose checks a day suffice...both of 
those recommendations are appropriate for some type 2s but they are not 
appropriate for any type 1s.

It sounds to me like your friend's GP thinks he is hot stuff. He is giving 
your friend a regimen that might sound 'cutting-edge' to him but would still 
be OFF-LABEL, even if it were prescribed to a type 2. Byetta is not 
indicated for use alongside insulin. It is for type 2s that have not yet 
begun insulin therapy. If Byetta does not get good results in a type 2 who 
takes it, the next thing to try is insulin therapy.

I would advise your friend to ring up Amylin (http://www.amylin.com for 
contact info) and request information on Byetta. She should take whatever 
they post to her to her GP and show him that the drug is not intended for 
type 1s and make him justify his recommendation of it with some clinical 
evidence. (Of which there is none at present.)

If your friend might like to be in touch with me personally for more info on 
the studies that have been done on Byetta, I will be glad to correspond with 
her.

Melissa
Type 1 13 years; MiniMed pumper 7.5 years; Animas pumper 2.5 years; diabetes 
care industry 3 years



----Original Message Follows----
From: "Nick Klee" <email @ redacted>
Reply-To: email @ redacted
To: <email @ redacted>
Subject: [IPk] Byetta / Lantus regime question
Date: Thu, 22 Jun 2006 13:00:27 +0100


Hi

Quick question for a (non-pumper) diabetic friend.  She is type-1 and has
been putting on a little weight recently (12pounds in 3 months).  Her GP has
suggested she try Byetta.  This was a completely new drug to me, hadn't
heard of it.  Been doing some reading and it looks interesting.  Obviously
her GP is prescribing it for it's "hunger controlling" effects.  So anyone
type 1's on here with any experience of Byetta?

Second question is about her treatment regime.  She takes one daily dosage
of 100u of Lantus as her 24hour basal, but takes NO insulin pre-meal.  Her
GP has only given her advise on correcting high blood sugars, using Humulin
R.  Note again, she has not been given a regime that gives her any pre-meal
boluses.


Now her eating routine is anything but regular, and she doesn't carb count.
Is it still normal for people to be treated in this way?  I just can't see
how she can hope to get any kind of control with that regime?  Her diabetes
care is handled by her local GP and a dietician, not a specialist (she lives
in USA).

I'd be very interested in anyones thoughts on this.  Also - she has Humulin
R to correct any high blood sugars.  Any reasons why she shouldn't be using
Humalog instead (with it's faster acting profile)?

Cheers,



Nick
.
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