diabetes

[intuition897]

I'm not diabetic (but I did stay at a Holiday Inn Express last night)...My Mom is diabetic. She has talked to me about her various struggles with it, although the impact on her sex life hasn't come up.

One thing we had talked about was a raw food diet. There's a new documentary in the works due out this spring called Raw for 30 Days, which is the antithesis to Supersize Me. Remember that documentary by the guy who decided to try eating nothing but McCrap for 30 days? Anyway, the took a group of 6 diabetics to a secluded retreat in Arizona and for 30 days they ate only raw food. Nothing cooked, baked, steamed, or otherwise heated. No dairy, no meat, no alcohol or caffeine. According to the trailer, the results were unbelievably dramatic. Diabetics who had been on the insulin needle for 20 years were off their insulin after 2 weeks. Blood pressure and cholesterol normalized (or at least dropped a LOT), major drop in excess body fat, increased sense of well-being, disappearance of other aches and pains. It sounds essentially like the body normalizes itself.

Now of course, the only catch is that you have to rethink the way you enjoy food. Develop a sort of zen-like appreciation for the beauty of nature's bounty in its most perfect and natural form. I'd get into it about 3 or 4 days: "Oooooohhhhhmmmm-this-uncooked-cold-vegetable-puree-with-no-salt-is-good-for-meeeeee....Aw shit, where the f#@* is the nearest barbecue? And where the hell are you hiding the meat? I need chocolate!! Just back away slowly from the chocolate and no one gets hurt."

It would be ideal, but it may not be realistic. Just thought I'd throw it out there anyway. I have no idea if this sort of tack might appeal to you or not, but if you want to read more about it: http://www.rawfor30.com/

[Scott & JoAnn]

Originally Posted by intuition897

I'm not diabetic (but I did stay at a Holiday Inn Express last night)...My Mom is diabetic. She has talked to me about her various struggles with it, although the impact on her sex life hasn't come up.

One thing we had talked about was a raw food diet. There's a new documentary in the works due out this spring called Raw for 30 Days, which is the antithesis to Supersize Me. Remember that documentary by the guy who decided to try eating nothing but McCrap for 30 days? Anyway, the took a group of 6 diabetics to a secluded retreat in Arizona and for 30 days they ate only raw food. Nothing cooked, baked, steamed, or otherwise heated. No dairy, no meat, no alcohol or caffeine. According to the trailer, the results were unbelievably dramatic. Diabetics who had been on the insulin needle for 20 years were off their insulin after 2 weeks. Blood pressure and cholesterol normalized (or at least dropped a LOT), major drop in excess body fat, increased sense of well-being, disappearance of other aches and pains. It sounds essentially like the body normalizes itself.

Now of course, the only catch is that you have to rethink the way you enjoy food. Develop a sort of zen-like appreciation for the beauty of nature's bounty in its most perfect and natural form. I'd get into it about 3 or 4 days: "Oooooohhhhhmmmm-this-uncooked-cold-vegetable-puree-with-no-salt-is-good-for-meeeeee....Aw shit, where the f#@* is the nearest barbecue? And where the hell are you hiding the meat? I need chocolate!! Just back away slowly from the chocolate and no one gets hurt."

It would be ideal, but it may not be realistic. Just thought I'd throw it out there anyway. I have no idea if this sort of tack might appeal to you or not, but if you want to read more about it: http://www.rawfor30.com/

Mostly BS. While a dietary regime of raw foods or mostly vegetable products will certainly be more healthy and lead to weight loss, thus affecting one's cardiovascular profile (BP, Cholesterol, etc) via weight loss, and as such with reduced weight comes less stress on joints (aches/pains), and of course this would have an effect on one's increased sense of well being.

All he promotes is healthier eating...essentially a diet. This of course is the demise of many T2 diabetics. Obesity is common in T2's and as such a heathier eating regimene would most definitely have an effect on a T2. ANY diet that reduces weight will accomplish what he implies.

However, it gets more complicated in a T1, which is an auto-immune disease. Diet will help, but they will always need insulin for glucose management.

T2's which progress to insulin have advanced to the stage whereby the pancreatic beta cells have burnt out and unless regenerated, the individual will require insulin medication. No diet, enzyme, or vitamin will restore activity to your beta cells.

There is only one synthetic peptide which has hope to restore/regenerate beta cell activity. Scientific name is exenatide or commercially, Byetta (marketed by Amylin Pharma/Eli Lilly).

Presently there is a study by the National Institute of Health (NIH) to determine IF exenatide does indeed regenerate the beta cell. This would of course be the 'Holy Grail' in diabetes treatment.

As I mentioned in an earlier post, IF I was a T2 diabetic I would be beating down the doors of my endo for a prescription for Byetta.

Scott & JoAnn

PS...I too stayed at a Holiday Inn Espress last night!

[bignads]

thanks to all for their input, Scott and JoAnn I sent you a message

[avid]

I think this is a really interesting discussion, both as a woman with diabetes, and as someone who is interested in nutrition (and making that good FOOD).

First, the nutrition points. I think we could ALL benefit from increasing the amount of raw food we eat. It doesn't HAVE to be boring, but it sure is a committment to eat that way. Any time we move away from processed, packaged (high fat/sodium, generally speaking), and move to a diet that comes from predominantly vegetable sources, we look at more work involved to bring it to the table. The question is, how much of ourselves are we willing to invest? It's MUCH easier to pop a pill, or in this case, take an injection. We all want a quick(-er) fix. (Says the woman who keeps opening the good bottles of red wine).

We haven't even talked about exercise, either. I'd sure love to see a randomized controlled trial that compares regular exercise with Byetta, metformin and the other drugs, along with good nutrition.

As for the Byetta, I think the jury is still out. From some preliminary research I did, the FDA is investigating a good number of cases of acute pancreatitis among users of this drug. Additionally, the side effects, including nausea and diarrhea sound pretty yucky. Geez, these may even account for the weight loss. Now, that being said, I don't seem to be a terribly good candidate for the medication anyway. I'm not very overweight (only about 15lbs), I'm quite fit, and my metformin already does a pretty good job of helping my glycemic control.

Now, if I were a man who is having ED problems, is quite overweight, and is having problems with glycemic control, you better believe I'd be checking it out for myself.

[dandawest]

Well to add my two cents this topic I would have to agree the diabeties does effect the body when regarding the sexual experience. There are the problems of ED and the minute man problem. Also for some of the males that try to regulate those problem with meds like viagra they don't always work.
I can also say from experience a healthier body works better, being a BHM with diabeties i had those problems. I was put on the Byetta 9 months ago and it is wonderful. have lost roughly 40 lbs (even though I dont trust scales) but have no clothes that fit due to size loss. I must say it is in pen for but still add syringe needle to give meds. I have had the side effects listed but other unmentionable.

[Scott & JoAnn]

Originally Posted by avid

As for the Byetta, I think the jury is still out. From some preliminary research I did, the FDA is investigating a good number of cases of acute pancreatitis among users of this drug. Additionally, the side effects, including nausea and diarrhea sound pretty yucky. Geez, these may even account for the weight loss. Now, that being said, I don't seem to be a terribly good candidate for the medication anyway. I'm not very overweight (only about 15lbs), I'm quite fit, and my metformin already does a pretty good job of helping my glycemic control.

Now, if I were a man who is having ED problems, is quite overweight, and is having problems with glycemic control, you better believe I'd be checking it out for myself.

Byetta & Pancreatitis was a subject that was brought up and mostly pursued by brokerage houses on Wall Street who were 'short' shares of AMLN. After studying the FACTS it is apparent that there is a LOWER indication of pancreantitis in Byetta users than in the overall diabetic or obese population.
The incidence rate of panreantitis is actually LOWER in Byetta users. I am venturing a guess you were misinformed by a GP or uneducated endo.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) about 80,000 cases of acute pancreatitis occur in the United States each year. That is a rate of about one case per 3750 persons. Thirty cases of acute pancreatitis would be expected in the general population for every 112500 person years. The first question is, for how many person years has Byetta been used? Then based on that number, what would be the expected number of acute pancreatitis cases?

It might be possible to make an accurate estimate of Byetta person-year usage based on the total scrip data. Those data indicate that about 200,000 people were using Byetta as of January 1, 2006, and that about 450,000 people are now using it. That gives about 600,000 patient years of experience with Byetta since launch. Using the rate of acute pancreatitis in the general population, about 160 cases of pancreatitis would have been expected in a random sampling of this size.

However, pancreatitis is more prevalent among diabetics than the general population, and studies have also found that obesity increases the risk of pancreatitis by about ten percent for each 5 units of BMI, and also increased risk of other pancreas-related disorders (1,2,3). Considering the use pattern of Byetta, and its beneficial side effect weight loss along with the problem of obesity in diabetes, it is safe assume that a large factor in prescribing Byetta is weight loss, and that the average BMI of Byetta users is much higher than the target of 21-25. An average BMI of 35 would give a composite increased risk based on obesity alone of 20 percent, and about 192 cases of acute pancreatitis would have been expected. Diabetes itself also increases the risk of pancreatitis, so it is clear that a reported number of thirty during the period since Byetta launch is far below the expected levels and supports the notion that Byetta has an overall protective effect against pancreatitis among diabetics.

Adding to that is the fact that many other drugs contribute to pancreatitis risk, including many that are commonly prescribed for diabetes. According to a Swedish study (2) the use of glyburide (Micronase, a sulfonylurea drug) increase the risk of pancreatitis by two and a half fold. This effect was noted as early as 1975 with another sulfonylurea drug, tolbutamide (4). Since the initial approval for Byetta was for use in conjunction with metformin and/or sulfonylurea drugs it is certain that many Byetta users were using other drugs that increased their risk. Thus well over 200 cases of pancreatitis should have occurred among Byetta users so far.

Also in the FDA report is data that not all of the pancreatitis sufferers had a quick recovery, although most did. About 80 percent recovered without further intervention, which is about the overall recovery rate according to the NIDDK, so this does not point to any added risk of a poor prognosis. In addition, obesity is not just a risk factor of developing pancreatitis, but also in the severity of the disorder (5), and again with a prevalently obese cohort using Byetta the rate of recovery is not alarming.

Could Byetta be a contributing factor in some cases of pancreatitis? It is entirely possible, but the overall risk benefit analysis seems weighted in Byetta’s favor. The reported occurrence of pancreatitis was much lower in diabetics using Byetta than would have been expected considering just the added risk due to diabetes and obesity. Other drugs such as Orlistat (6), used to treat obesity, and Captopril (7), used to treat high blood pressure, for example, could also increase the risk in some persons. Only by a full understanding of all these potential contributing factors can Byetta be accurately assessed vis a vis pancreatitis. More needs to be known, yet at this stage it seems it is better to use Byetta than not to.

Finally, what could this mean for Byetta LAR? It is too early to tell how that program might be effected, but consider the only published case study of a person effected by pancreatitis while using Byetta (8). The patient developed symptoms of pancreatitis very soon after initiating Byetta treatment, and then was removed from all drug treatment, including other drugs that have a known effect of increasing pancreatitis risk. The case resolved itself quickly with no need for intervention. Although pancreatitis recurred after Byetta was reintroduced, the authors conclude that the other drugs cannot be ruled out as contributory. Thus, all that can be said is an association between Byetta use in this case and pancreatitis, not a cause and effect relationship. As for Byetta LAR, patients would likely not begin incretin therapy with the long acting version. It would be more prudent regardless of a potential pancreatitis issue to start with a low dose of Byetta, and titrate it to allow the patient to acclimate to the therapy. Only then would Byetta LAR be introduced, and by then it would be unlikely that an adverse event would occur.

Scott

[Scott & JoAnn]

Originally Posted by avid

We haven't even talked about exercise, either. I'd sure love to see a randomized controlled trial that compares regular exercise with Byetta, metformin and the other drugs, along with good nutrition.

This has actually been done. It is also a subject of discussion on how drup companies report data from the various trials of therapies in developments.

What Amylin did when they were in the development and trial stages with Byetta, was to be very specific on WHO they entered into their trials. They selected individuals who were FAILING their existing medication and who were also involved in exercise intervention, but still could not achieve adequate glucose control. In other words, these folks are already doing everything they can to achieve control, but can't do it. Enter Byetta.

Byetta was added to the medications of these folks. Amazingly the majority achieved glucose numbers <7%, which is the FDA's recommend level for nomal glycemic control. Additionally, weight loss was noticed en mass. What has also been revealed is that the weight loss does not plateau. Translation...weight loss continued even after 2.5 years of monitoring. Presently Byetta is awaiting approval for a monotherapy indication...translation, it will not have to be prescribed to be added to existing medications (metformin, etc). Studies show Byetta achieves its numbers without the other meds and as such, other medications might be discontinued once the Byetta regimen is started. It will be prescribed as a stand alone therapy...actually many physicians already do this (off-label). Hopefully in 2009 there will be a Long Acting Release (LAR) formula of Byetta which will allow for a once-a-week injection of Byetta vs the twice-a-day version presently in use.

With weight loss comes better overall metabolic control (lipid profiles), less stress on joints (fewer aches/pains), which naturally will allow folks to feel better and become more active. There have been additional effects that have been reported on many diabetic blogs for those using Byetta. Some of these include better vision, arthritic conditions deminished, endema diminished, less joint swelling, and yes...those with ED have reported fewer incidents.

The nausea/diarrhea you mention are well documented side effects that are shown to be transient and diminish in a week or two. Most, not all, of the nausea has been reported to actually be a feeling of 'fullness'. Byetta acts on the brain receptors that tell you that you are hungary. Habits are hard to break. Byetta will tell your brain you are full, but until you adjust WHEN you inject before the meal, you may eat your 3 plates of food BEFORE the Byetta kicks in telling you that you are full. Translation...you have now overeaten and feel uncomfortably full or nausea. Physicians are recommending injecting earlier before your meals (45 minutes). Eventually you will adjust and only eat one plate of food and feel full. This is how the weight loss is occuring, NOT by throwing up or diarrea.

Byetta will transform how diabetes is treated. It is just that it is a complete paradigm change for the medical community. Physician education is needed. Byetta should be the first therapy initiated once a diabetic is diagnosed. NOT the last therapy after all else has failed. Reason: Metformin/sulfunyrea are bandaids and only slow progression of the disease. Byetta not only immediately allows one to achieve glucose control and mitigate weight issues, but two areas which are rarely discussed and weigh heavily (pun intended) for a diabetic, are post prandial glucose excursions (glucose fluxuation) and beta cell health.

Glucolse fluxuations occur after meals. Sugar levels swing wildly. Byetta absolutely keeps these in a narrower band, which is better for all your major organs/overall health. Metformin does not offer control of your post prandial excursions anywhere close to what Byetta does. This is well documented. Beta cell health is the 'Holy Grail'. This is what produces your insulin. Byetta appears, studies to confirm out soon from NIH, to restore beta cell function. NO OTHER MEDICATION ON EARTH DOES THIS...PERIOD. So it's almost like the old FRAM commercials, "you can pay me now, or pay me later". The earlier Byetta is initiated, the less you will be paying later in life, with regards to diabetic complications...and we all know what they are and how bad they can be.

The problem with Byetta, is actually a problem with people. People like pills vs needles. Now Byetta IS an injectible, however, not a traditional injectible. It comes in a pen...looks like a marker. It has 30 injections in it. It is administered 2 times a day, just prior to a meal. Majority report they can not even feel the injection and have a hard time knowing if it went in or not until used to the process. Additionally, health providers prescribe the most inexpensive medications. Byetta is not cheap, may not be on some formularies, and you may have to fight to get it. It IS getting easier. You just have to be informed and find the right physician. GPs/PAs (general practicioners/physician assistants) are medical 'handymen' and are NOT informed as to how to prescribe other than those therapies used for decades.

My recommendation for those borderline diabetic or beyond. Find a KNOWLEDGEABLE endocrinolgist. One who knows about Byetta and has experience with it.

For those with T1, I'd suggest the above, but ask about Symlin for your treatment regimene.

Regards,
Scott

[avid]

Thank you for the VERY thorough reply, Scott.

You wouldn't happen to be a drug rep by any chance, would you?

[Scott & JoAnn]

Originally Posted by avid

Thank you for the VERY thorough reply, Scott.

You wouldn't happen to be a drug rep by any chance, would you?

Nope...but I did stay at a Holiday Inn Express last night.

Scott

[Spoomonkey]

Sometimes you just have to lighten the mood

Spoomonkey

[BiloxiCouple]

Originally Posted by Spoomonkey

Sometimes you just have to lighten the mood

Spoomonkey

They ought to use that in a real commercial I would remember it.

If not a drug rep then maybe an endocrinologist? They stay at the Holiday Inn Express too.

[sweet_tna]

Originally Posted by Spoomonkey

Sometimes you just have to lighten the mood

Spoomonkey

ROFLMAO!!! I just had to send this to my future sister-in-law (who works for the Diabetes Foundation).

=)

[Scott & JoAnn]

Originally Posted by dandawest

Well to add my two cents this topic I would have to agree the diabeties does effect the body when regarding the sexual experience. There are the problems of ED and the minute man problem. Also for some of the males that try to regulate those problem with meds like viagra they don't always work.
I can also say from experience a healthier body works better, being a BHM with diabeties i had those problems. I was put on the Byetta 9 months ago and it is wonderful. have lost roughly 40 lbs (even though I dont trust scales) but have no clothes that fit due to size loss. I must say it is in pen for but still add syringe needle to give meds. I have had the side effects listed but other unmentionable.

dandawest,

Congratulations are in order! 40 LBS in 9 months is great! I am assuming your 'numbers' are also satisfacory and that you are noticing other benefits. Has your GP/Endo followed up with complete metabolic profiles? Have your markers improved? My guess is after being on Byetta for 9 months the answer is YES. Have you noticed increased activity levels?

If I might ask what meds were you on prior to the Byetta and have you been able to reduce or discontinue any of them? Additionally, are you being treated by a GP or Endo? Have you had a C-peptide test? THIS is important and GPs and even most endo's will not request this test.

C-peptide, once thought to be a throwaway peptide, had been for years an enigma. If this peptide was unnecessary, why does it persist in serum? The evidence now is that C-peptide has important physiological roles in maintaining cell health. Many of the papers cited even provide evidence that C-peptide might play a small role in improving glycemic control, possibly by enhancing insulin activity.

It has been recommended that large-scale clinical trials to bring C-peptide into the clinical arena should be implemented (Sima, 2003). An alternative might come from a potential benefit of treatment with Byetta. It has already been established that Byetta improves beta cell health and restores first response activity of insulin in type 2 diabetics. This would be expected to result in an increase in C-peptide along with the increase in endogenous insulin.

At the least, the possibility of improving both insulin and C-peptide by giving a single drug could be beneficial to type 2 patients who are failing to control serum glucose with oral medications. Yet it is also known that many of the complications of diabetes such as neuropathy, retinopathy, renopathy, and microvascular disease have begun long before patients lose their responsiveness to oral medications. THIS is the point I was trying to make in prior posts, that the earlier the introduction of Byetta, the better the payoff later on...FRAM "pay me now or pay me later".

The cumulative effect of years of C-peptide deficiency, on top of the suboptimal glycemic control inherent to the disease, has set these complications in motion. If so, then drugs (Metformin/Sulfonyreas/Januvia) that are directed at insulin sensitivity are not the best way to prevent complications.

The only way currently available to increase C-peptide in diabetics is to stimulate insulin production, and Byetta is the only drug so far that has been shown to not only stimulate insulin production, but also improve beta cell health. It would seem, then, that some careful thought should be given to introducing Byetta much earlier than when patients are failing oral medications.

Again, those who are diabetic or newly diagnosed, should be better informed on treatment options. IMHO, there is only one. Byetta for T2's. Symlin for T1's.

Scott

[two4youinswva]

Originally Posted by Spoomonkey

Sometimes you just have to lighten the mood

Heh heh. That's good. Thanks for sharing it.

Diabetes is no laughing matter.

BUT, I think we can all giggle at "Diabeetus".

[BiloxiCouple]

I make fun of alot of things around here. But at times I have to be serious.

So... on a serious note. Diabetes sucks. I was diagnosed as a type II last year. My medication was too strong for quite a while. Which meant I was crashing alot. My sugar would drop and I couldn't think, make decisions and the wife says I would get mean/nasty and you act kind of drunk. Plus it just wears you out afterwards. Finally got my medication adjusted where I can balance it most of the time with diet and medication. The diet part is tough too. Still trying to learn that and failing alot. Then in the same time I ended up having 2 heart caths and 7 stents within a six month time frame. Plus a nasty old heart murmur that is teasing me now. Then there is the side effects of the medicines which mess you up from time to time. Did I mention the allergies. Yuk. Did get my cholestorol under 100. Yeah. Did I mention the side effects. Yep. Sometimes they hurt real bad. Then they told me I was overweight Duh!! I can't get a colonoscopy or have my tooth worked on because of the heart medicine. Fortunately it's not an emergency right now. Didn't I say diabetes sucks?!! One day at a time and try to lose the weight. I'm not an expert at this, this is just my daily life in a summary.

I remember the days of being able to turn a 5 minute mile. That was another life.