Byetta: He-Ya! Not A Karate Chop But How A Lizard Helps Diabetics
When I was staying at a resort in Puerto Rico ten years ago, there was a restaurant called, “Iguanas.” It was an outdoor restaurant on this small beach island surrounded by beautiful vegetation and palm trees. When the tortillas arrived on the table, we were suddenly surrounded by little lizards, like a scene from Jurassic Park. I’m not afraid of spiders or snakes, but lizards and frogs scare the dickens out of me. As I was yelping and standing on my chair, my partner said to me, “Well, why do you think they call this restaurant ‘Iguanas’?” Are lizards that disgusting?
Today, diabetics can thank lizards for improving their health. The Gila Monster (pronounced He-La – sounds like a karate chop) has a protein in the saliva that caught the interest of researchers years ago. Why? Could you imagine only needing to eat three or four meals—a year? The gila monster does! Many Americans eat three or four meals before lunchtime.
There are several factors that allow the gila monster to require so few meals, and one of them is due to incretin. Incretin is a hormone that controls blood sugars, slows down the stomach and nutrient absorption in the gut, and…tells the brain, “I’m not hungry.” (The man-eating flower in Little Shop of Horrors could use some incretin.)
Researchers tried to deliver the gila monster’s salivary protein into humans, but the body resisted it. So Amylin Pharmaceuticals and Eli Lilly developed a synthetic version, called Byetta. Byetta is not an Italian sandwich. It is an incretin analog that became FDA approved April 2005 as adjunctive therapy in Type II diabetics who are already on Metformin and/or a sulfonylurea (e.g. Amaryl, Glucotrol). PETA will be very happy the gila monster is left alone by these companies, in particular former PETA spokesperson Naomi Campbell—who wears furs and probably lizard skin skirts.
Byetta does require two shots a day: breakfast and dinner. Most people have some nausea and upset stomach with this initially, but most do not complain about it because most people lose on average 6-7 pounds in the first 4 months. I share an office with an endocrinologist, Dr. Christopher Zitnay, and we have seen patients on Byetta lose much more weight on Byetta within just a couple of months. It isn’t as dramatic as Oprah on Optifast, but the studies have shown continuous weight loss after 3 years. All commercial weight loss programs and fad diets show 98% failure to keep weight off after 3 years, so Byetta’s success in weight loss appears to be very significant.
More importantly, hemoglobin A1C (HbA1C) levels significantly drop with Byetta. HbA1C means how “sugar coated” the oxygen carrying molecules in the blood are, and HbA1C is used to measure the control of a person’s diabetes. In Type II diabetes, the goal is to have a HbA1C < 6.5%, because every 1% above this level is associated with a 20% increased risk of diabetic complications.
Byetta lowers blood sugars in diabetes by a few different mechanisms. Glucagon is a pancreatic hormone that increases blood sugars and tend to be abnormally high in Type II diabetics. Byetta lowers glucagons secretion. Insulin is another pancreatic hormone that lowers blood sugars, and Byetta increases insulin secretion when blood sugars are high. Also by slowing down the absorption of nutrients in the gut to prevent a BLAST of sugar into the bloodstream, Byetta allows the insulin to work more effectively.
Symlin is similar to Byetta designed for Type I diabetics, but that is another article in itself.
Am I afraid of lizards today? Well, I was trapped in Cancun after Hurricane Wilma, and my partly destroyed room was a sanctuary for lizards. I was so tired and dirty that instead of being terrified, I welcomed them into our room. I even named one lizard Iguana Trump.
© John S Hong, MD, MS November 2005
