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Friday, June 08, 2007

Confessions of a gillyspitkin!

Among the many things I am, I can now add the label "gillyspitkin"!

Starting on May 23 I began injecting lizard spit into my stomach twice daily -- once when I get up and then just before dinner.

"Lizard spit" is the term used by the blogosphere's "Byetta" community -- folks like me with Type 2 diabetes who have shifted from one medication to another over the years in an effort to avoid having to take insulin. It is called lizard spit because the basic "chemical" in exenatide (its generic name) is derived from the saliva of the Gila Monster. And so folks who take Byeta call themselves "gillyspitkins.

With all the news about Avandia, Actos, etc -- and with the growing numbers of folks suffering from this malady -- one ought to be a bit anxious about taking this new drug. There are, after all, side effects to consider.

There is, for example, the possibility of nausea and other "gastrointestinal" issues, but none have proven widespread or serious.

And since it is typically taken in conjunction with other meds intended to lower glucose levels (in my case, glipizide, a sulfonylurea class drug), there is the possibility of a hypoglycemic episode. (I had one last night when I took the injection too late -- that was a bummer....)

But then there is the most notable of side effects -- weight loss!

Yes, list among the side effects is the fact that in clinical trials those who took Byetta recorded a 2.3 kg weight loss over 26 weeks -- not much, in deed, except for the fact that almost every other type of diabetes medication generates weight gain -- or at least bloating (I can confirm all that!). What's more, most folks in the blogosphere report more substantial weight loss (others note the weight loss varies). This is a side effect that in fact works to make the diabetic healthier!

Which leads to the question: in what way is Byetta like Viagra?

For those who do not know the story of sildenafil (the generic name for Viagra), it was originally developed as a medication for treatment of hypertension and forms of angina (the legend is that it was actually being developed to stimulate hair growth). In any case, the participants in the field studies reported involuntary penile erections, and eventually the drug was patented to deal with male erectile dysfunction. The rest is history. (Which raises another question: do they prescribe Viagra for hypertension?)

Exendatide's weight loss capacity may end up doing the same for Byetta, although it is sure to retain it diabetes control purposes as well. There are reports of non-diabetics seeking prescriptions for the drug (see NYT article), and given it high safety scores (at least for now) we may have a real, honest-to-goodness way to counter obesity through medication.

The injection process is not that bad -- best place to insert the needle is in the flabby part of the stomach right above the waist (the "love handles"), although upper arm and thigh are also possible injection sites. The key to Byetta's effectiveness is timing -- you must eat within one hour of the injection, and never take it after eating. There is also a temperature factor, but as long as it is kept refrigerated before its first use -- and otherwise generally at room temperature -- all is a "go".

There does not seem to be a serious downside to this medication, although some bloggers report its effectiveness degenerates over time. Thus far, however, it has earned a reputation as a "monster drug" reflecting its derivation as well as its success for many....

We will see....

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