Recently I have had 2 patients successfully treated with Byetta for 18 months that suddenly became ill without any abnormal pathology or abnormal scans.
They have both proceeded to insulin and are now requiring up to 200 units a day U500 INSULIN. Has anyone had a similar experience and any thoughts behind why?
Apparently with merely increasing insulin production with Byetta, they finally developed a higher level of insulin resistance. Did you try any insulin receptor sensitizers (Metformin or Actos)? Type 2 diabetics generally develop insulin resistance quite quickly if they are not placed on a medium low carbohydrate diet along with adjusted medication levels. Insulin receptors are also senditive to changes in lipid raft constructs ie. Changes in chloesterol levels ( very high or too low). Another possibility is adevirus infection. Adenovirus is known to increase up to fourfold the secretion of PC-1 which is an insulin receptor inhibitor. In this case biguanidine (again Metformin) will decrease PC-1 activity, or if your patients are also anemic, a two month treatment with EPO has been known to return PC-1 levels back to normal limits. Hope this gives you something to go on...
I have never seen so sudden illness in patients on exenatide. They can develope megaloblastic anemia but in this case I wouldn´t search any connection to exenatide treatment - EBV virosis?
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