Diabetes.Blog.com

1 - I'm putting my injection procedure at the top of the new forum here to make it easier for new people to find.

Here's a reprint of the injection procedure to minimize Byetta drops on your needle.

I attach the needle to the pen and perform the injection. I inject 3" to the right of my navel, holding my left wrist against my stomach to steady the pen (also in my left hand). This is important as it's difficult to turn the pen button while holding the pen straight). Be sure to hold the pen firmly.

While the needle is in my skin I carefully turn the button to the "10" (or 5 if you're on 5mcg dosage) on the dial and push the button.

Then I count to 10.

With the needle still in my skin I turn the button until the arrow points up...toward the button.

I count to 5 then remove the needle from my skin, remove the needle from the pen and discard the needle.

The pen is now ready to go next time...with the arrow pointing up to the button.

Be careful returning the pen to the fridge as you must not touch the button. This can cause a drop to form on the next needle you use. If you keep the pen in it's original box then be careful returning the pen to the white plastic tray that the button does not come in contact with the tray.

It seems the advantage of this is that all of the twisting of the button is done while the needle is in my skin. Any drops that are produced become part of the injection and are not wasted.

It pays to be careful & take your time doing this as the pen must be held very firm & still while in the skin and the button is being turned. You must have enough light to be able to see the dial on the pen while it's inserted.

John (Comment this)

2 - Sherry/Beth, re: Taking Byetta with high bg's

Upon injection, Byetta does one of two things based on your bg level:

It triggers a "first phase" insulin dump if a rapid rise in bg is detected. As soon as you inject, your kidneys go to work filtering Byetta out so you need to eat to get this response before enough Byetta has been filtered out to reduce or eliminate this reaction.

If you're in a hyerglycemic event when you take the shot...that is.. bg's over 600 then the Byetta will cause an immediate insulin dump.

If your bg's are say 200-500 because either you're eating or just ate then that rapid rise in bg's that Byetta is waiting for will have already happened. You will not get the first phase response because you bg has already "rapidly risen" before you took the shot.

Hope this helps,
John (Comment this)

3 - Forgot to mention...

It's that first phase insulin response that T-2 diabetics lose, that is restored with Byetta.

John (Comment this)

4 - Good Morning Ron:Cindylou
You are right Cindylou is doing a great job as always. Knowing She is there for you as a true friend helps me to get through a lot. Thanks Cindylou for ALL you do for me.
Newbies: Wow you are all doing so great! Overcoming the fear of that first injection is a big hurdle. All of you cleared it in A-1 style. If any of the side effects do get you you know to come here for help.
TEST OFTEN!! Thats the best advice I can add to everyone elses. Keep those bgs from getting too low while on byetta.
And as you newbies already know you have the best bloggers on the internet right here to turn too.
John: injection
I think your idea is perfect to list it on the start of each weeks blog. Makes it easier for the newbies who are new to computors to find. Hope all is well with you. The time and effort you,Ron Toni,Cindylou. Shari give to this blog everyday is so committed. You all deserve stars.You also Pat . Donna feel better soon. Hopefully by Wedenesday my time will free up enough to come back on a regular bases. I miss my byetta babes and byetta hunks!!!Stay well everyone. My thoughts and prayers are with everyone on this blog. I miss you all.Good Health! (Comment this)

5 - John, thanks for the correction! I didn't understand the bit about Byetta having to catch the first phase rise in order to work.

The Starter Kit: I thought everyone got it! It's a box that doctor gave me when I started. It contained a lot of literature and a videotape about byetta, how it works, how to prep the pen, and how to inject. I also was given my first 5 pen with it, and about 20 pen needles.

Maybe Amylin is only giving them out to endocrinologists?

Good luck to those of you just starting out this weekend. I hope it goes well and easily.
 (Comment this)

6 - Beth I think your right only the endo's have them.Thats how I got mine. And when I need a new meter also. John is great! He reads and researchs to give us the best knowledge on diabetes and byetta.Good Health (Comment this)

7 - my endo also gave me the starter kit, and his nurse showed me how to use the pen. In addition, when I left the office, the drug rep was waiting to see him with more starter kits for him. (Comment this)

8 - Beth, re: First Phase Response

Yep, that's why taking the short BEFORE the meal is critical... The first phase response (insulin dump) begins 2 minutes after you start eating and last 10-15 minutes.. It would be easy to miss if you take the shot during the meal.

Second phase response then immediately follows with additional insulin until your numbers return to normal.

John (Comment this)

9 - Thanks Beth and John for the information. (Comment this)

10 - John
It would seem Lunch and dinner would be better times to take the shots. Why was breakfast choosen? I am getting my best reading of the day on waking up - 130 to 160. As you see, I still haven't been blessed by Byetta after 6 weeks.

 (Comment this)

11 - Hi Everyone,
I was diagnosed with Type2 a few months ago, and after a nasty reaction to Metformin, I was given the option of insulin or Byetta. I started Byetta (5 Pen) last month and graduated to the 10 Pen last week. I have noticed a steady decline in my BG's especially with the higher dose. I have also lost 16 lbs so far, mostly due to the nausea. A few days ago I noticed a small blemish at one of my injection sites that has since turned into several large round/oval shaped rashes that are slightly raised and itch like crazy. I have tried just about every ointment with no success and was wondering if anyone else has had this reaction? It seems to be spreading to any area I inject and I am getting nervous. Any info would be greatly appreciated.
Lee Anne in KS (Comment this)

12 - Hi, everyone.
First, for John, what happens when you inject Byetta when your BS's are already ok (e.g., 107)? I don't know all the workings of the drug. Your info answers a lot of questions, but I didn't see anything about this (maybe in a previous forum?).
Second, I said I tell you about my first post-Byetta experience. My BS was 107 before injection and dinner. After I ate a sandwich and banana, BS was 125 about 90 min later and stayed around that til bedtime another hour later. Side effects...hmmm...maybe it was my imagination. Either I had none, or they were very mild. Had a tiny headache (as compared to the migranes when I was in my 20's-40's) and felt MAYBE a bit queasy, but that could have been nerves caused by obsessing about whether there would be side effects! All in all, I am pleased. My morning BS was 192, which is a bit below where I expected it to be in the low to mid 200's or so. I was tempted to do another injection before breakfast, but my doctor said to do them just a dinner for a month. So we will see what develops. I'm sure I'll be visiting here many times in the next 30 days (and longer). I saw someone suggest keeping a food log, so I'm doing that with times, food, meds and injections, and how I felt afterwards. I love having others to talk with. Was looking on the other forum to see who all was in Oregon. But that is for another forum, yes?
 (Comment this)

13 - Here in San Diego I have Kaiser Permanente. My Endo is wonderful but he gave me no such starter kit, only an RX for Byetta. The pharmacy provided me with only the pen in a tray and limited instructions. I will be going to a Diabetes Nurse Coordinator tomorrow for injection instructions. I had to get a separate RX for the needles which were not provided with the Byetta. I was given the BD Ultra Fine III short pen needles 31G X 5/16" (8mm). Hope this is the type that is best for first time users. I also was NOT given anything to put the used needles in so I imagine any sealed container will do... right? (Comment this)

14 - Re: starter kits
Hi, Pam. I think I got a partial starter kit. It had the video and some of the mini needles and a booklet, but no pen of any type. The needles you got are what my doc prescribed for me too. They seem to be fine, appeared to me to be very short, so I can't imagine how short the mini's must be! Supposedly there is a card in the starter kit I got that you can send in for a travel carrier or something. I store my pen (in its original tray and cardboard container on top of the butter (hmmmm...) in one of the door compartments (has a little flip door) of my frig. (Comment this)

15 - Lee-Ann: Welcome to the blog and Gilly[byetta]. There is a blog for skin complications.Scroll back to the top of blog. Hit byetta blogs and click on "skin complications" you will find several byetta users discussing your problem. It is a side effect some have hopefully they can guide you through it. Our Cindylou is one who is well versed in it. Good Health
Pam yes any sealed container will do.
Cathy W. Welcome to the blog and our Gilly club[byetta users] We will be here for you whenever you need someone. So join in as often as you like. (Comment this)

16 - Dick, Breakfast and dinner are the recommended times because you need at least 6 hours between injections to keep from having too much byetta in your system at one time. I have read of some here who do lunch and dinner when they are sufficiently far apart. Pat in Idaho (Comment this)

17 - Cathy W, if you click on Who and where are you.you can scroll down to see if oregon is listed. But even if its not we may still have Oregon but they choose not to list there e-mail. Not everyone does. (Comment this)

18 - Pat in Idaho:Just wanted to give a shout out to you. Hope Gilly is treating you well these days. I havn not been able to post too much lately. But I try to sneak a peek at the posting at least once a day. You have become one of the committed posters. your advice and guidence,I am sure is appreciated greatly. stay well. (Comment this)

19 - Thanks Danielle. I'm doing well. Gilly continues to be my friend. I have been able to splurge from time to time which did slow the weight loss, but come right back to controlling my eating with its help. There weas a week in February when I had my grandson's birthday, a superbowl party and out of town conference where the food is all good and fattening. I think it took me two weeks to undo the damage from that week weight wise. I've lost about 30 pounds now. Pat in Idaho (Comment this)

20 - Pat in Idaho..We have all taken those steps back. I guess the important thing is to get back to our gilly control when were done. 30 pounds is impressive. Especially with all that going on. April will be my downfall..several family birthdays..2 showers..christening...and a wedding! I can feel the pounds coming on all ready. OH! well I am sure Gilly will do his best to help me behave. I know for sure He WILL punish me if I get to bad. LOL Stay well. (Comment this)

21 - Cathy W. When I called Amylin with a question they immediately mailed me a little carrying case for the Byetta pen but it is only good (I have been told) for like a couple of hours time since it goes in the fridge and isn't frozen. But it will be good for short jaunts like tomorrow when I bring my pen to the instruction class on injecting. I got the case for free and there are other cases online I have been referred to for longer durations called MEDICOOL. Someone emailed me and told me it was the best and he travels with it. I am a little concerned over the instructions posted on injecting as it sounds like it is "critical" to keep this pen steady and how it is stored, etc. Do you turn the "button" with your other hand while holding it with your injecting hand then? (Comment this)

22 - Dick, re: Timing of Shots

As Pat says. the important thing also is to have 6 hours between shots..

One other point we haven't talked about here before is that it's important to take medications that depend on fast absorption from the stomach (like antibiotics & contraceptives) with a meal where you didn't take a Byetta shot. The slower passing of food through the stomach and lower absorption affect these drugs.

Some days I have only 2 regular meals... like Sundays..so I take a shot around 10am and another around 5pm.. I do oberve the 6 hr apart rule and the 60 minutes or less before a meal time.


Cathy W, re: Injecting with 107 bg

If you inject and your bg's are already ok then the Byetta will wait to deal with the next rapid rise in bg's..Meanwhile the kidneys are busily filtering it out of your blood... SO, it depends on how much Byetta is still in your system as to whether it can sufficiently react to food intake.

btw: It's not uncommon for those who have bg's in control to take a shot at 107 (normal) bg. At worst, it's a wasted shot if you don't eat a meal in the next 60 minutes.

Your bg at 125 after an hour from eating a sandwich and a banana shows the results of the Byetta in action.

John (Comment this)

23 - Pam, re: Injection Technique

I posted my instructions in extreme detail because some people had trouble visualizing how to do it. The whole idea is to have the pen needle in the skin when the button is being touched.. this is when it's most likely to drip or produce a bubble on the tip of the needle.

Some people here have an allergic reaction to haveing Byetta touch their skin..others see the drop as wasted Byetta that should've been part of the latest injection.

Holding the pen steady in one hand and twisting the button with the other is critical. It's not as difficult as it sounds but you certainly want to hold it firm so you don't wiggle the needle-end of the pen while injected into your skin.

John (Comment this)

24 - Thanks for the clarification. I also have another concern and that is the blood pressure medicine I take (even though I do not have high blood pressure), 20 mgs of Lisinopril. My doc wants me on it just the same because of diabetes. After reading about people's experiences I am wondering if Byetta will drop my already pretty low BP to dangerous levels... periodically. The only time I ever have elevated BP is when I am stressed or in pain. So I am wondering if I should stop taking it once I am on Byetta. (Comment this)

25 - Pam--first, I have only done one injection so far, being a real newbie, but it is my understanding that once the pen has been "set up," after that all you have to do at each injection is put on a new needle, do the turnings until the unlined dosage shows in the window, then holding the pen like you were going to stab someone (ooh, yourself in this case), insert the needle into your site (tummy or leg or arm), push the end button with your thumb, hold down the button and slowly count to 5 or 10, release the button and remove the pen. I can't deal with some of the other instructions (if these are the one to which you refer) about leaving the needle in then do all this stuff with the pen. I'm just happy to have the injection finished! I might try John's technique (posted at the top of this forum) someday, but that day is way off I suspect.

Thanks for the info on the holder. I will either call them or see if I have the postcard referred to in the starter kit.

Also, Pam, on re-reading your post I see I missed a word while I was reading. You asked about where to store your used needles (while my head was reading where to store your pen...well, duh for me). You can purchase a "Sharps" container at a local pharmacy. Mine is a red container, think it says something also about bio-hazard (I am NOT a bio-hazard) with a lid. You put all your lancets and needles in there and when it is full, you take it to the pharmacy where you bought it and they will dispose of them for you. I assume that is basically what you are paying for--i.e., the disposal, because the plastic tub can't be all that expensive. I think I paid around $9 but that was years ago (and I still haven't filled it). Does that answer that question? (Comment this)

26 - Hi, John--So to further clarify about injection with normal BS's, would you suppose it would be best then to eat sooner (within the 1 hour period), so there would be more Byetta in your system to combat the rising BS (vs. eating later in the 1 hour when maybe some of the Byetta is already on the way out). I mean, as I think I understood you to say, the Byetta doesn't just sit there, it is almost immediately that the body begins getting rid of the Byetta, right? (Comment this)

27 - Cathy W. Yes, thanks! I should have asked for a container then at the pharmacy. Here in SD you can put the container in the trash as long as it is taped shut/sealed in some way. That is if you don't have a doctor or pharmacy willing to take them back. I did have some one email me about how they do their injection and they actually leave the needle way, way long to prevent having a drop remain in the needle or waste the "gilly juice"..! So for most of you "injectors" out there it sounds like a total of about 10 to 15 seconds of leaving the needle in the skin is sufficient. I am still a little concerned about this set up...which I haven't read up on ...YET. Thanks to all. (Comment this)

28 - Hi Everyone!---Started Byetta 5pen two weeks ago. The only side effects I have had are constipation,and feeling full as soon as I eat and staying that way for a long time,and on several occacions very bad indigestion. My bs before taking this was 104-114 on metaglip 1000mg a day but by ac1 score was 6.99 so my endo wanted to try this because of weight issues and my ac1 level. but......... my bs has gone up to 150-155 in the mornings before doing anything and stays around 178 all day long even at nite when I take my byetta injection before dinner. What gives? Am I not a candidate for this drug? Is anyone else have problems with this also? Is this normal? Help!! Thanks (Comment this)

29 - Also... the refrigerator "carry kit" for the Byetta pen that is provided FREE by Amylin was requested from their Customer Service 800 number and received just a couple of days later. (Comment this)

30 - Cathy W.

Byetta reaches median peak plasma concentrations in a little over 2 hours. As long as you eat between 1 minute and 1 hours you will reach the maximum benefit. (Comment this)

31 - Pam,re: Lisinopril

There is an interaction between Byetta and Lisinopril which delays the time it takes for the Lisinopril to reach maximum strength by about 2 hours. There are no other interactions between the 2 drugs.

It is unlikely that Byetta, alone with drop your bg's too low...unless you are taking a sulfonylurea like Amaryl or Glucotrol.

Stress & pain (and illness) all cause elevated bg's in T-2's.


Cathy W re: Time for Byetta to Act

I've not read any studies about when during the hour it is best to eat...and that was not a factor during the drug trials.. But, from reading the comments on this blog people seem to feel that they get maximum appetite supression by waiting to eat until the hour is nearly up...and if they suffer from nausea as a side effect of Byetta then people here have found that eating at the 15 minute mark seems to work best.

To your comment about the Byetta "just sitting there" , keep in mind that 2.4 hours after you take the shot there is still half the Byetta still active in your body.. and it's not gone until 9-10 hrs after the shot.

jeez...good questions.
John
 (Comment this)

32 - Karen, re: BG's on the way up

I wasn't quite clear.. are you still taking the 1,000 Metaglip or was that replaced with Byetta?

Also, are you only taking 1 Byetta shot a day (in the evening)?

John (Comment this)

33 - John. Thanks for the info. I normally take my diuretic and my acid reflux med in the early AM so I plan to do that before my injection. Do I have to wait the full hour before injecting because if I do I will run out of time prior to leaving for work? Normally I take my Lisinopril and Lovastatin (20 mg) and Zetia 10 mg before the evening meal along with the other cap of Omeprazole for my acid reflux. I used to take the Actos 15 mg which I will stop effective tomorrow, also. Question is... can I take these meds before the injection or should I wait until 2 hours after? Since the stomach will slow down digestion after injecting I would think it best to continue prior, but not sure. I normally take only 1.25 mg twice a day of Glipizide and usually only at lunch and just prior or after dinner in the evening. Have seen some contradiction over when to take meds. I want to get the optimal effects of the Byetta but I also want to protect my "overly sensitive" stomach. I sure don't want to slow down the help the Omeprazole gives my stomach! (Comment this)

34 - PAM:RE: INJECTION SIMPLYFIED;
John's technique is great for those gillyspitkins who are experiencing either of the problems he mentioned. Not everyone does, and I happen to be one of them. I set up the pen as the initial instructions say in the kit. I then carefully put the needle in, at a slight angle, inject, count to 20 and pull it out slowly. You have both hands free to do this. If you are one of the many who can do this with no problems occuring, then that's all you need to do to successfully inject. Best wishes. (Comment this)

35 - PAM: RE; ONE HOUR WAIT:
I know you directed this question to John, but I would just like to say that from my experience, with an empty tummy in the morning, I find that one half hour is more than enough time for any meds to leave my stomach and be effective. The one hour time had been stated as a "general rule" for making sure the meds would be out of one's stomach before injecting, due to the slower emptying of the stomach afterwards. (Comment this)

36 - Pam,

You should have no trouble taking everything at once. I have been for 3 months with no trouble... but I've gotten a little confused...can you list the meds, strengths & doses so I can look again...

(for example...mine are)

Amaryl, 2mg (1x) before breakfast
Byetta, 10mcg (2x) before breakfast & dinner
Metformin, 1,000 (1x) before breakfast

Thanks,
John (Comment this)

37 - CATHY W.RE; TIME TO START EATING;
Once again, I can only speak from my own experience. I mentioned a little farther back that I have found that if I eat immediately after injecting, I find that I can have a higher number than the two hour number.. at three hours post injection, especially if it is a fairly high carb Meal. As I have said, this has been my experience, and indeed the appetite supression will have not kicked in yet also, so you would have to be very careful to eat light, even though you may still feel hungry. (Comment this)

38 - John. Prior to breakfast upon rising I take 1 cap of Omeprazole (10mg) and 1/2 of a Hydrochlorothiazide (25 mg). I take 1.25 mg of Glipizide at lunch and with or after dinner. I sometimes take a little in the AM, too if my overnight numbers are up. Then before dinner I take 20 mg of Lisinopril, 20 mg of Lovastatin and 10 mg of Zetia. (why, I don't know since my labs in Dec. showed total cholesterol at 180, Tryg. at 198, LDL, 90 and HDL, 50. I also take a 325 mg capsule of Quinine at bedtime for cramping in my feet/legs. I am stopping the Actos of which I previously took 15 mg at the same time with the other meds [prior] to dinner. (Comment this)

39 - john... Oops. Forgot to list the second 10 mg dose of Omeprazole w/the evening meds. (Comment this)

40 - Pam, re: Drugs R'Us

If I read your note correctly you say that you "amy take Glipizide after dinner"..

Did your doctor prescribe it that way?

The reason I ask is that Glipizide is in the sulfonylurea class of drugs and can cause hypoglycemic events..which can be made more severe since you are using Byetta.

There are others here who've found they have good bg control except, like you, they sometimes have elevated fasting (morning) bg levels. Some have managed this by taking a small amount of carbs right before bed.. Others here can comment from experience.. I've never tried this.

John (Comment this)

41 - CATHY W.:RE: TIME TO START EATING;
I'm not sure if I made the point that I have found that eating immediately after injecting does not work well for me. I usually wait at the least, fifteen minutes.
 (Comment this)

42 - I am finishing my 4th month on the 10pen. Side effects are really hard on me. Vomiting two to three times a week; heartburn and diarrhea. I am skipping a day sometimes to see if it helps. It has not. I am going to ask the doctor if I may skip the morning shot and just do the evening one. Also thinking of going back to the 5pen. Has anyone else tried these ideas? (Comment this)

43 - Pam, I have seen it documented that Byeatta taken at the same time as Lovastatin decreases Lovastatin's effectiveness. (med sheet from my pharmacy) You will want to be sure that the Lovastatin is 1 hour before or 2 hours after as recommended. Pat in Idaho (Comment this)

44 - John. I was basically instructed to take Glipizide either before or with my lunch and dinner. I got in the habit of taking it a while after dinner only because it is at night that if I have any carbs to speak of I spike up so all this talk about eating a few carbs at bedtime amazes me. Carbs have been my enemy. I only began taking the Glipizide later because I figured the later I took it the longer it would work to help my overnight spiking issues. Well, it hasn't helped and there is no rhyme or reason as to why my AM numbers tend to be high. Not always, but a lot of the time it is that way. Because my A1c has been so low the doc never seemed concerned about it. I was originally prescribed 2.5 mgs of Glipizide twice a day but it caused me to go hypoglycemic at times, especially at the dinner hour when I was taking the Actos. So with cutting my dose in half I managed OK. Then the Actos was working so well that many times I just stopped taking the evening dose of Glipizide altogether or I would dip too low on my blood sugar. Right now I am spiking with any carbs most... any time. Not a good time and the Byetta will be a welcome to hopefully get off those other meds permanently. (Comment this)

45 - LOVASTATIN:
Pat, didn't your pharmacy, or your doctor recommend that Lovastatin be taken at bedtime.. mine did.

 (Comment this)

46 - Pam,

Glad to hear you're getting off the Actos.. I took Actos 45's for about 3 months and filled up like a water balloon.

re: carbs..as it turns out...some here have found that taking a small amount of carbs affects the Dawn effect in a way that results in lower morning bg's..

As Pat mentioned, Lovastatin interacts with Byetta to somewhat lessen the affect of the Lovastatin. Again, it's that slower absorption through the stomach here.

John (Comment this)

47 - Then it sounds like Lovastatin should definitely be taken an hour before Byetta or like Shari does, at bedtime. I was always told to just take in the evening... no specific time. Would it be advisable to take all those meds I stated earlier just as I get home from work then.. about 5:20 pm? OR possibly even before leaving work. I want the benefit of both Byetta and the meds I need. How to figure out what is the best time is the problem. Odd that here at Kaiser no one has mentioned any of those disclaimers or concerns about Byetta, but then like I have stated previously, Byetta isn't usually prescribed by Kaiser Permanente. It is new ground for many of their doctors and pharmacy staff. (Comment this)

48 - PAM-Lisinopril
After 6 months on Byetta, I have recently had to cut my lisinopril(Zestril) from 20mg to 10 and the hydrochloro-thiazide from 25 to 12 1/2 due to lower blood pressure that made me feel like I was hypoglycemic when I wasn't. The loss of weight probably had something to do with it. I consider it an added bonus from Byetta. (Comment this)

49 - Toni. I only take 1/2 of the Hydrochlorothiazide as it is and I do so only because I tend to retain fluids in my hands and feet/ankles. Is it for blood pressure as well? They may just take me off the Lisinopril altogether since I don't have high BP. My primary care doc only wanted me on it to protect my kidneys he said. With elevated Creatinine level I need some help. Anyone out there familiar with Byetta's affect on the Creatinine level (of waste filtered)? My level has been 1.2 but when I was on an anti-inflamatory drug a couple of months ago (low dose) it jumped to 1.6 and I was immediately taken off of it. (Comment this)

50 - i am still having problems with my pens. I find particles in them towards the 3 week of use. they are replacing them each time for no cost but it is disturbing. they said that it was pieces of the plastic coming loose. I am no happy that they are unable to fix this problem. how many people are noticing this problem? (Comment this)