Diabetes Monitor - Frequently Asked Questions

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Frequently Asked Questions — Byetta Basics

The following Byetta FAQs were originally compiled by a reader Mark Abbott, and reviewed by other readers, John Granger and "Ron in Brooklyn."
Mark updated this webpage in May, 2008.
Many thanks to all of them for their efforts!

Topics covered in this FAQ:

Byetta Basics
Blood Glucose Control
Weight Loss
What Caused This?
Eating
Pen Setup
Injections
Side Effects
Byetta Storage
Byetta Travel
More Byetta Information

Welcome to the world of Byetta, sometimes known as "Lizard Spit" since the original protein used to synthesize Byetta was found in the saliva of the Gila Monster - one of only two poisonous lizards in North America.

Byetta can be a key to help control your blood sugar, and located here is some basic information based on real-life lessons learned by a group of Byetta users, which can help you get through some of the new experiences you may encounter.

The first thing you need to keep in mind is that the primary purpose of Byetta is blood sugar (glucose) control — usually abbreviated as BG. Weight loss is a wonderful side effect that some people have experienced; but not everyone.

Do not let the postings in online forums and blogs scare you away from trying Byetta. Online resources often attract people who are having issues and are seeking assistance. Many people are using Byetta with little or no side effects.

Byetta was approved by the FDA for prescribed use in April 2005. Here are some of the “lessons we have learned” during the first few years of Byetta:

Byetta Basics

The manufacturers of Byetta (Amylin and Lilly) have an excellent website at: www.byetta.com which provides a great deal of new user information.
Byetta injections are recommended to be taken at least 6 hours apart.
- Byetta has a “half-life” of 2.4 hours, thus 50% of the Byetta is gone from your system after approximately 2-1/2 hours, and the Byetta will be completely cleared out of your system after approximately 9 hours.
You must begin eating your meal within one hour after taking the injection.
- For most people, the closer you eat to the injection time, the less nausea.
- Eating near the end of the one hour window can help appetite suppression.
Taking a shot and not eating does no good - you have to eat after the shot.
- Byetta works when the body detects a rise in blood sugar; if you do not eat, there will be no rise in blood sugar and the Byetta shot is wasted.
Byetta slows emptying of the stomach. Thus meds taken at the same time as the Byetta shot could be slowly dissolved in the stomach and prove to be less effective than intended. It is therefore wise to take meds at least an hour before or a couple of hours after injecting. This is especially true regarding metformin, which is frequently taken after a regular meal since it can cause an upset stomach. Please follow your doctor’s directions for medications that must be taken “with” food.
Since Byetta slows the gastric process, constipation is a common side effect.
- Adding additional fiber to your diet can help.
- Many users have seen good results from using fiber supplements.
- It is also a good idea to drink plenty of water.

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Blood Glucose Control

You should test your blood glucose (BG) regularly, and track the test results.
- BG Test results are important information for you to review with your regular doctor or endocrinologist.
- It is generally recommended that you use a new lancet for each BG test.
Some new users find that BG readings fluctuate erratically during the first few weeks using Byetta.
- This is not unusual; you should continue your diet and exercise programs.
- Patience is required during the early transition period from another therapy to Byetta; soon you will establish the improved BG control you seek.
During the clinical trials Byetta and metformin, used in combination (without other diabetes drugs), did not cause "Lows" or hypoglycemia.
- Using a sulfonylurea drug like Amaryl with Byetta can result in a low BG, or hypoglycemia. Watch for low BG levels and discuss with your doctor.
- If your BG gets too low you can drink some fruit juice (Apple or Orange seem to be the fastest acting), eat some honey or eat some glucose tablets.
Taking a Byetta shot when your BG level is high can cause the Byetta to over-react and you can quickly “crash” to a low BG. If your BG tests high before your shot you can either skip the shot, or be very careful by monitoring your BG closely and have some glucose tablets or fruit juice on hand in case you become hypoglycemic. Heed the manufacturer’s warning and do not take the shot once you begin a meal or afterwards.
- What is a “high BG”? It is whatever you would consider as High for you!
- After a short period of testing you will have a record of your “normal” high and low readings. Over time, your “normal” BG levels may change as you adjust to the new medication and dietary changes.

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Weight Loss

Byetta is not a magic potion; you must work with it. Proper diet and exercise will help maximize weight loss effects. Any exercise is better than no exercise — do what you can without causing yourself pain.
Exercise may cause your BG readings to go up instead of down. You will have to find out what exercise, and at what level of effort, works best for you. You want to maximize your exercise while minimizing high or low BG levels.
- Good results have been reported with as little as 20 minute periods of exercise, while other people have to exercise 60 minutes or more.
- Set a daily exercise target and try to achieve that level of exercise each day. If you miss a day, don’t despair - just aim for the target the next day.
Be patient in your weight loss goals. Some people see dramatic weight loss (40-50 pounds in 6 months) while others see very little weight change. Don't get on the scale every day; every couple of days or twice a week is enough.
- Reports indicate that 25% of Byetta users see significant weight loss (usually those who have the most weight to lose), 50% see moderate weight loss, and 25% see minimal weight loss.
- Your weight loss will probably not be as significant if you already have good eating habits.

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What Caused This?

You are a unique individual, and you may experience results or side-effects that are different from what the general population is reporting.
One of the most important things you can do is to keep detailed records of your medicines, BG test results, side-effects, food and exercise.
Patience is very important. Do not start changing meds or doses on your own. Always confer with your doctor first.

If you decide, with your doctor, to change something, change only one thing at a time. Otherwise you will not be sure which change provided the new results.

Higher BG reading in the morning:

Having a higher BG reading in the morning when you have not eaten anything after dinner the night before is often referred to as the Dawn Effect. This can occur immediately after waking in the morning when your body is pumping out glucose to help you get ready to be active.
Sometimes eating a small amount of carbs before bedtime can help reduce the Dawn Effect. Some foods that may help reduce the Dawn Effect are a small amount of dark chocolate, a few almonds, or a small piece of candy.

Eating

Byetta is reactive — if you do not eat enough carbs in your meal you may not trigger the Byetta and you will not see the expected positive BG impact.

An initial rule of thumb is to eat 35-45 carbs with each meal. However, you have to track your carbohydrate consumption and your BG testing to determine what is the best level of carbs for you. Some people do very well eating less carbs “per day” than the recommendation in the rule of thumb.

Nausea — some people report having nausea when first injecting Byetta.
- See the section labeled “Side-Effects” below this section.
To help with weight loss - Stop eating at the first sign of feeling full. You may be surprised at how little food you need.
- When you eat carbs, make sure they are complex carbs (whole grains, etc.) and not simple carbs (refined flour, crackers, etc.)
- There is a great deal of diet information at the Diabetes Monitor with links to other good diet websites.
We recommend that all Byetta users should take a multi-vitamin every day.
Drink plenty of water; hydration is very important.

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Pen Setup

You must execute the pen set-up process when you start using a new pen.

Pen Set-up should only be done when you start a new pen — do not do a pen set-up before each shot.
There are excellent directions for pen set-up included with each pen, and there is a very good video on the Byetta website at www.Byetta.com — click on the "Getting Started on Byetta" tab at the top of the page, then the "Byetta Pen Tutorial" is at the top right corner of the getting started page.

A brief explanation is to attach a pen needle and then "shoot" the medication into the air once or twice (3 times is rarely required) until you see the liquid actually come out of the needle (it helps if you aim the needle at a mirror or a dark piece of paper).
When initial pen set-up is complete you merely attach a needle and proceed with your injection each time you use the pen in the future — no additional set-up is required after the very first time you use the pen.

Do not store the pen with a needle attached; this may cause leakage.

It is recommended that you use a new needle each time you inject Byetta.

The Byetta in the pen may be contaminated if you see any of the following:

If any blood is drawn back through the needle into the Byetta pen chamber.
If there are any particles in the Byetta pen chamber big enough to sink.
If there is any discoloration of the Byetta in the Byetta pen chamber.
If you see any of the conditions listed above — contact the Amylin Lilly Customer Support Center toll-free at 1-800-868-1190 for directions.

Small bubbles in the Byetta pen chamber are fairly common.

If you see a very large bubble — contact the Amylin Lilly Customer Support Center toll-free at 1-800-868-1190 for directions.

Injections

There are directions on how to inject on the Byetta website at www.Byetta.com, and on the printed patient information enclosed in each Byetta box. If you received a starter kit from your doctor then the video tape that’s included will have step-by-step demonstration.
Byetta can be injected in the lower abdomen, the top of the thigh or the upper arm. Generally Byetta will be absorbed the fastest when injected in the thigh or abdomen, and slowest when injected in the arm.
Occasionally there will be a small drop form on the end of the needle after you have injected. This is not a problem, as the pen has enough Byetta to provide a full 30 days of injections.

To minimize drops, make sure to press and hold the pen injection button "firmly" for at least 10 seconds. You can also rotate the pen a few times with the needle still under the skin — in effect "wiping" the needle off inside your body.
If you still have problems with “drops” or leakage, try the following procedure: after holding the injection firmly for at least 10 seconds, continue holding the pen firmly in one hand, then use the other hand to dial the pen to the first indicator while the needle is still under your skin - this will avoid any potential leakage that can form droplets.

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Side Effects

The most common side effects are:

Nausea (with vomiting in severe cases)
Constipation
Rash at the injection site

Nausea Relief

The best relief for nausea is to not get nauseous in the first place:

Limit your food intake — you will feel full much faster that in the past.
Avoid greasy foods and foods that are heavily acidic in content.
When you find something that makes you nauseous, keep a log so you can eliminate that food from your diet.

If you get nauseous you can treat it externally or internally:

Internally:

Over-The-Counter options — Some folks use over-the-counter anti-nausea products like Tums, Alka-Seltzer, Rolaids, etc.
Drinking a carbonated beverage will help you belch, and that will help relieve gas buildup which in turn can reduce nausea.
Eating a small amount of food before bedtime seems to help limit the nighttime nausea.
Ginger — Many people get nausea relief by eating or drinking food with ginger (cookies, soda, etc.).

Externally:

Sea Bands - Anti-motion sickness wrist bands that can be purchased at most large drugstores (Walgreens, etc.).
Duct Tape - Apply a 3-1/2 inch strip of duct tape on your stomach, two inches above the navel (some apply it below the navel) and leave it on during the day, remove it before bedtime, washing the area and then apply a moisturizer. (Sounds crazy, but some folks swear by it!)

Constipation
- Drink lots of water.
- Eat foods containing fiber.
- Take a fiber supplement (Benefiber, Metamucil, etc.)

Rash at the Injection Site
- A rash at the injection site is sometimes caused by the Byetta coming into direct contact with the skin. Avoid direct Byetta contact with the skin as follows:
- Always use a new needle for each injection of Byetta.
- Follow the directions above to minimize “drops” on the needle.

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Byetta Storage

Present Byetta storage requirements are different than those that were recommended when the medication first became available.
Current Byetta storage requirements are to refrigerate new/unopened pens between 36 degrees Fahrenheit and 46 degrees Fahrenheit until first use.

Most household refrigerators can handle this temperature range.
Purchase a refrigerator thermometer to assure that your refrigerator is maintaining an acceptable temperature range.
Frost-free refrigerators (most common type in the U.S.) will cycle the temperature as they run through the “frost-free” cycle.

After you start using a Byetta pen it does not have to be refrigerated.
- Byetta pens must be stored at temperatures below 77 degrees (room temp).
- Temperatures higher than room temp (76 degrees) must be avoided. High temperatures will damage the Byetta.
Byetta must not be exposed to freezing temperatures. Freezing temperatures will "kill" the Byetta.
During the summer, or when traveling where temps may exceed 76 degrees, it is recommended that you keep the Byetta pen cooled by using an external refrigeration unit, a cooler, a small thermos or a Frio pen wallet.
- Never leave a Byetta pen in a vehicle with no temperature control.

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Byetta Travel

Information about Traveling with Byetta can be found at the DiabetesMonitor website: www.diabetesmonitor.com/m77.htm

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More Byetta Information

Information from other readers about their experiences with Byetta can be found at DiabetesDiscussions.com. Look for the folder called "Discuss Byetta" to read what others have commented; you can sign up, then enter your own questions or answers!
Information from other readers about their experiences with Byetta can also be found at Diabetes.Blog.com, located at http://www.Diabetes.Blog.com. Byetta topics there can be found at the List of the previous Byetta forums. These are available for review, but you can't post new comments at them.
You are welcome to read postings without entering your own messages.
Do not be afraid to post questions; we have all asked them at one time or another, and someone probably has an answer for you.
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Webpage updated at the DiabetesMonitor 10May2008

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