Monday, March 9, 2009

Diabetes and Byetta

In case the "Title" didn't clue you in... This is gonna be one of them-there "Diabetes-Related-Posts" so if this subject matter bores you... "Move along... Nothin' to see here!"

So I was diagnosed as Type 2 in December '07. I probably had "Metabolic Syndrome/Pre-Diabetes" long before that. But that's a separate rant that falls under "Why I don't trust Doctors" and best left for another time...

"It is what it is."

I now have a doctor that I *do* trust. She's an Assistant Professor at Stanford's Endocrinology Clinic. She's helped me make HUGE progress in the past 6 months - and I feel WORLDS better than I did!

Anyhoooo... Over the past couple-three years, I've gained an enormous amount of weight - no matter WHAT I did. Exercise more? Eat less? (Cut fat/Cut carbs/Eat Cabbage Soup/Drink Protein Shakes/Eat Nothing/Ad Nauseum).. Uhhh... Nothing worked!

Since my diagnosis, with the veritable cornucopia of pharmaceuticals I've taken, the weight-gain has not only continued, but increased at an alarming rate! I don't want to say exactly how much I've gained, so let's just say that it's A LOT!

Along with that, I am highly-highly insulin resistant. My problem is not that my pancreas can't produce enough insulin (it produces plenty, actually). It's that my body can't/won't utilize the insulin properly. In fact, about the ONLY thing about insulin that does seem to "work" for me, is it's ability to convert food (glucose) to FAT. Ohhhh yeah, it does that VERY well!

Doc switched me over to Humulin R U-500 which is 5x the strength of "normal" insulin. That actually metabolizes very well for me and I've definitely seen a HUGE improvement in my Blood Glucose [BG] numbers. I remain highly carbo-phobic, however. Carbs send my BG#'s thru the roof, but the U-500 insulin (in conjunction with *strict* carb restriction) works extremely well and I am happy to report that - as of February anyway - I am now a Proud Member of the "5% Club!" My last A1c came back at 5.7 (I'd started out at 11)! So "Yayyyy Me!"

The U-500 does work very well. And, in fact, my weight gain has *slowed* significantly. But... I'm still gaining!!! My hope was that if I got my BG#'s in-line, that the weight gain would stop and - maybe, just maybe - get replaced with weight LOSS, right?

Not so, Kemosabe!

Yes, I feel better... Yes, I have a *bit* more energy... Yes, I *have* increased my activity levels (from being a total slug [NOT by choice!] to being able to take the stairs at work and work in the yard)... I even took it a step further and started experimenting with cutting back carbs to ridiculously low levels (aimed for 20g or less, managed to maintain appx 40g/day) and cut back calories (aimed for 1300, managed to maintain appx 1600 cals/day)... I even started dialing back my insulin usage as far as I dared (to the equivalent of appx 300 units/day - which was as low as I could go without experiencing spikes) (and I've NOT been able to maintain that, I had to ramp-back-up to 390u/day). I worked on that DILIGENTLY for one solid month...

The payoff?! Ohhhh, I ONLY gained 7#!!!!

Words cannot describe.................................................

Anyhooooo... During my early-Feb appt with my endocrinologist, I expressed Extreme Dismay over my inability to lose weight - no matter what I did!

See, it seems I'm stuck in a Vicious Circle with my Insulin Resistance and High Insulin Requirements. It seems the more insulin I take, the more weight I'll gain. And the more I weigh, the more insulin I'll need. So add more insulin, gain more weight, and need still MORE insulin!

"Lather. Rinse. Repeat."

So we kicked around a few ideas and finally settled on Byetta (Exenatide). Byetta is an incretin mimetic that was originally derived from some sorta poisonous lizard. I don't claim to know a whole helluva lot about it (despite my Googling the hell out of it!), but the Bottom Line is - it seems to "play well" with T2 diabetics and helps with BG control. And one of it's side-effects is weight loss. That seems to (mostly) come from the fact that it slows digestion so you feel "fuller" for a longer period of time (but the downside to that is you might end up getting nauseous)...

It is not FDA approved for insulin-dependent diabetics, and it's not prescribed as a diet medication - but I've heard-tell of many insulin-dependent diabetics who have had WONDERFUL success on this medication (likewise, there are many who it hasn't worked for).

But since I seem to be a bit of an "Extreme Case," she agreed to let me try it. First, we wanted to draw more lab tests and make sure it wasn't contraindicated in my case. Plus, I wanted to do a bit more Googling...

Well, during my early-March appt, she wrote the prescription for it. She also warned me about side-effects (which are plentiful - and some sound pretty nasty, especially "Acute Pancreatitis!"), and gave me a list of things to "watch-out for." She basically scared the beejezus outta me!

I have found a good Support Board: Diabetes and Byetta

Anyway... I started the Byetta last Friday... One of the (many) things the doctor warned me about were hypos, so I dialed-back my insulin before I started it, and also ramped-up the carbs. I figured it was safer for me to run higher numbers initially and then tweak it from there.

I have posted to the D&B board, but I thought I'd also post my results here - in case there are any Diabetic "lurkers" out there who might find this interesting..

Here are my notes about starting Byetta @ 5mcg:

  • I've had no stomach issues - other than a little burpy-gas, and I'm starting to get a bit more "brave" about what (and when) I'll eat after I take the injection.

  • I can't say that I necessarily feel "full" faster - and certainly not over-stuffed after eating. But as long as I remain vigilant and eat *less* - I'm finding that I don't get ravenously hungry a couple of hours later. So I'm going to call that a "subtle" improvement (Meaning: I have to pay attention to it - NOT that it's an "insignificant" thing!).

  • I haven't found any foods that "disagree" with me (yet!) - so I'm counting myself very fortunate (If I had to give up BBQ pork ribs... Arr! Don't go there!) (Of course, I haven't tried BBQ pork ribs since I've been on it!) (But when/if I do - it'll only be a couple of small ones!)

  • I have been able to cut my insulin usage by appx 25% (from 390 units/day to 300!). My avg BG has risen slightly (avg 130 now - it had been in the 115-120 avg range before) - but I'm attributing that to increased carbs. I'm going to start experimenting with dialing the carbs back.

  • I've had NO hypos. But I have had a few "spikes" over 170 - and one over 200 (again, carbs are to blame - and that was partially "by design" b/c I wanted to ramp-up my BG#'s while starting Byetta).

  • Even when I do spike, it drops back and stabilizes pretty quickly. This is another positive improvement (previously, if I hit a 200+, I'd be sick, and my BG would be all-over-the-board, for a full 24 hours+ afterward)

  • Yesterday, I had lunch w/a friend at a Mexican Restaurant. Tortilla Chips are like cocaine in that they're highly addictive... I also had a "real" margarita (with sugar and everything). Yes, I sinned. Yes, I spiked. No, I didn't suffer (Yay!).

  • Normally, after sinning like that, I could expect to see a 3-4 lb. gain the next day - plus I'd feel like a Zombie. Today I felt surprisingly good, first thing this morning, ANNNNNNND... The scale (a very accurate model, BTW) actually showed a 1 lb drop! Yaaayyyy!!! (No, I don't intend to make a habit of it - but I'm happy to know I can indulge ONCE in awhile!)

Soooooo... I'm thinking and hoping that this IS gonna work for me! In fact, I think I'll even upgrade from "Guardedly Optimistic" to "Fully Optimistic!" I expect to stay @ 5mcg for a month (longer, if I feel comfortable with my progress). I'll probably upgrade to 10mcg at some point though.

And I'm still experimenting w/food (especially carbs) and insulin dosages. I'd like to get my avg BG#'s down a bit lower and need to figure out how best to dial-it-in (Obviously Mexican Food ain't the way go!)...

No comments:


View my page on Meet the Phlockers