Bydureon is a once weekly form of Byetta, an increasingly popular diabetes medication.  It has a variety of effects that make it a useful treatment for diabetes.  Most importantly, it helps lower blood sugar and has tended to help people lose weight.

Effects

Bydureon lowers fasting glucose levels, has tended to result in weight loss, and helps lower HbA1c levels.  Chemically, it is very similar to glucagon like peptide 1 (glp-1), which is something your body naturally secrets after eating.

Glp-1 helps you digest food as well as serve as a signal that you’ve eaten.

Efficacy

Studies have shown that Bydureon has significant effects that are positive.  On a purely chemical level, 77% of those on Bydureon achieved target HbA1c levels.  It also probably helps you lose weight.  In one study, participants lost around 4kg on average.

How does this impact your life?

One large study gave participants a Diabetes Treatment Satisfaction Questionnaire, which consists of 6 items scored 0-6 and general satisfaction questions.  The total score is 36.  Those who took Bydureon had about an impressive 5 point change in their score, with an average improvement of 1.3 in rating of satisfaction with treatment for diabetes.

That means that treatment with Bydureon has tended to improve people’s satisfaction with their overall treatment for diabetes.

Long release versus instant release

Byetta has already been available as a twice daily injection.  How does it compare to the once weekly form?

First, the most important note is that once weekly dosing is a lot easier than twice daily.  Especially since Byetta is injected.

Some studies have shown superior results achieving target levels for the long release form than the instant release.  In one, for instance, 77% of those on long release achieved target HbA1c levels, while only 61% of those on instant release did.

One study showed that people thought instant release and long release were about as effective.  That study,  however, showed that people rated long release as significantly more convenient than instant release.

Side effects of Bydureon

26.4% report nausea

17.6% report itching or discomfort at injection site

13.5% report diarrhea

10.8% report vomiting

~10% report constipation

4.7% report injection site bruising

Around 5% of those on Bydureon report a “serious” side effect.

Some people on Bydureon develop antibodies to the medication.  This was mostly not an issue but could lead to allergic reactions.

Concerns

Because of how Bydureon works, it may influence your body’s digestion of other medications.  This may be significantly important for contraceptives and antibiotics.  Additionally, one study showed that levels of Tylenol were significantly effected by Byetta.

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Treatment of Diabetes

There are two major types of Diabetes: Type I and Type II.

Type I is typically genetic and is caused by the body attacking itself, destroying the cells in the pancreas that create insulin.

By contrast, Type II is typically caused by a combination of genetic predisposition and lifestyle choices, and is generally associated with being overweight.

The two types of diabetes have the same end result: there becomes too much sugar in the bloodstream, which causes a lot of problems.  But their treatments are different.

What does Insulin do?

Insulin helps the body digest and remove glucose, or sugar, from the bloodstream.  It is released from the pancreatic cells in response to the digestion of glucose.  Insulin effects almost every cell but is particularly important in the

Muscles, where it promotes the conversion of sugar into glycogen, a form used to store store

Liver, where it also promotes the conversion of sugar into glycogen

Fat cells, where it promotes the conversion of sugar into fat

Treatment for Type I Diabetes:

Type 1 is characterized by limited to no production of insulin, and treatment for it focuses on replacing the insulin that the body isn’t making.

A key problem in doing so is that insulin is a protein, so it can not be given orally as the stomach will digest it. Also, insulin tends to first pair up with itself, then form into larger complexes that take a long time to be broken.  This means that insulin by itself takes a relatively long time to start acting, so it has to be taken a while before eating, which is inconvenient.

Chemical modifications to insulin help solve the speed of delivery problem.  By exchanging two chemical parts of insulin, a lysine and a proline, the interactions that promote aggregation are disrupted.  This makes the insulin quickly accessible, which means it can be taken almost before a meal.

This instant release form of insulin helps replicate the spike in insulin that the body releases to help digest a meal.  It does not, however, mimic the low level of insulin that naturally exists.  To do so, other insulin derivatives were made, particularly glargine and detemir.

Glargine is a chemically modified form of insulin that, while a liquid in acidic environments, becomes solid in the body.  This means that it hangs around for a lot longer, ensuring a low baseline level of insulin activity throughout the day.  Detemir works similarly, but is made by attaching a fat to insulin which makes it harder for the body to remove.

Typical treatment combines long acting insulin with short acting to try to mimic the body’s natural pattern.  Failure to do so can result in blood glucose irregularities which can, if done poorly, cause a diabetic coma, or worse.

One innovative treatment approach is a continually connected monitor/release system.  The system can allow for greater control over insulin levels; on the other hand, it has to be worn continually, and patients non-adhering to doctor’s orders can possibly be worse with it.

Metformin, brand name Glucophage

You may be taking or considering metformin if you have Type II diabetes, “prediabetes,” or, though the scientific evidence for its use isn’t so solid, polycystic ovary syndrome.

Metformin works in several ways. It helps certain parts of the body respond properly to insulin, reduces how much glucose is released into the bloodstream, and does a few other things.

Most of what we know about Metformin is good. It doesn’t seem to cause weight gain, and in fact, may cause slight weight loss. It’s affordable. And it has 4 decades of use, meaning we know a lot more about it than many other medications.

One study showed that use of metformin over several years reduced mortality – or death - rates related to diabetes by an impressive 36%.

Side effects of metformin

Metformin’s side effects are mostly mild and treatable, though there is a the rare chance of a problem called lactic acidosis. About 30% of users experience some sort of side effect, including indigestion and diarrhea.

Taking metformin with a meal is one way to reduce problems, as well as taking an extended release version. The immediate release form has about a 17% rate of diarrhea, for instance, while the extended release has only about 8%.

Some have complained that metformin makes them smell bad.

Lactic acidosis is a very rare side effect that is fatal about 50% of the time. Estimates of how often it occurs range from 1/30,000 patient-years to a bit higher.  But assuming you meet the criteria for using metformin, most likely you shouldn’t worry about it.

Most doctors strongly feel that the benefits of metformin outweigh the risks of lactic acidosis.  As one doctor puts it, “Of 10,000 diabetic patients treated for 10 years with metformin, only 10 will die from lactic acidosis. [Based on a large study] of those 10,000 patients… metformin would [have prevented] 500 diabetes related deaths.”

Because of how effective metformin seems to be, some doctors argue for more aggressive use of the medication than is currently done.

Most common metformin side effects: nausea, metallic taste in mouth, some weight loss, vomiting and abdominal bloating.  Cramping or a feeling of fullness is also fairly common.

Talk to your doctor: if you feel excessively weak, have heartbeat changes or irregularities, chest pain, or signs of an allergic reaction.  Some people experience hypoglycemia, or too low blood sugar, on Metformin, which is also important to watch for.  Signs include chills, weakness and dizziness.

You may need to stop use if you are going to get an X-ray or scan that involves injection of die into your body.

This list does not include everything; see manufacturer’s insert for more.

Notes

Metformin can cause Vitamin B12 and folic acid deficiencies, so make sure to be eating a well balanced diet.  Additionally, remember that the initial and ideal treatment for type II diabetes is exercise and improved diet.

And it’s important to take metformin as your doctor directs.  It takes a while to start working and needs to be taken as recommended.

There are several conditions which mean you shouldn’t take metformin, like kidney problems. It’s possible that a significant amount of the lactic acidosis occurs in people who, according to the strict guidelines, shouldn’t have been taking the medication.

Related articles:

1. Bydureon Diabetes Drug, Side Effects
2. 10 Tips for Living With Type 1 Diabetes
3. What are the symptoms of Diabetes?

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