Byetta: A new weapon, but not a gun

When I was staying at a resort in Puerto Rico 10 years ago, there was a restaurant called "Iguanas." It was an outdoor restaurant on a 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, "Why do you think they call this restaurant 'Iguanas'?"

Today, diabetics can thank lizards for improving their health. The gila monster (pronounced he-la­ sounds like a karate chop) has a protein in its saliva that caught the interest of researchers years ago. Why? Can you imagine needing to eat only three or four meals– a year? The gila monster does! Many Americans eat three or four meals before lunchtime.

Several factors allow the gila monster to survive on so few meals, and one of them is incretin, 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 to humans, but the body resisted it. So Amylin Pharmaceuticals and Eli Lilly developed a synthetic version, called Byetta.

Byetta is not an Italian sandwich. In fact, it gained FDA approval in April 2005 as an adjunctive therapy for Type II diabetics who are already on certain drugs. (PETA will no doubt be very happy the gila monster is now ignored 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: at breakfast and dinner. Most people have some nausea and upset stomach with this initially, but most do not complain about it, because besides reining in the A1C hemoglobin levels, Byetta has a curious byproduct: most people lose on average six to seven pounds in the first four months.

I share an office with an endocrinologist, and we have seen patients on Byetta lose much more weight on the drug in just a couple of months. It isn't as dramatic as Oprah on Optifast, but the studies have shown continuous weight loss after three years.

All commercial weight loss programs and fad diets show 98 percent failure to keep weight off after three years, so Byetta's success in weight loss appears to be very significant.

Byetta lowers blood sugars by a few different mechanisms. For starters, 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.

There's another interesting new drug called Symlin. Like Byetta, it's another gila monster incretin analog, but it's designed for Type I diabetics. And that's another article.

Am I afraid of lizards today? Well, when writing this column two weeks ago, I was trapped in Cancun after Hurricane Wilma, and my partly destroyed hotel room was a sanctuary for lizards. I was so tired and dirty that instead of being terrified, I welcomed them in. I even named one lizard Iguana Trump.