Full Version: On Byetta - Nausea Much Worse in the Evening - I need help

From: Lala (GTFOI) [#1]
28 Sep 2009
To: ALL

First of all let me say thank you to the creater of this site & the folks who moderate & post here. It has been an invaluable tool in my learning process & gives me hope for recovery every time I come here. So many times I've gotten a question answered by reading your posts--thanks to all.

On to the latest...

I have noticed that I get much more nauseated after my evening dose of Byetta. I have dawn syndrome & have started taking Levemir at night to counteract it but still have readings around 160 or higher upon awakening. Don't know if that has anything to do with this or not but thought I would include the info in case it does. My readings through the day are usually in the 110-160 range. I have been on Metformin for about 6 months now--I take both pills at one time in the afternoon per my Dr.'s advice.

The morning dose of Byetta is such a breeze that sometimes I wonder if the pen is working, then comes the evening dose. Within 15 minutes or so of finishing eating supper the nausea is so bad that I am virtually incapacitated for a couple of hours each night. I don't really want to complain to the Dr. because this is the first time I've been able to control by BS numbers to any degree & I am losing weight as well--which I feel will ultimately be the best thing that could happen.

I stick to app. 30 carbs in the am, another 30-45 through the day (lunch & snack) & about 30-35 in the evening.

Any help at all would be much appreciated. I am pretty miserable right now. Thanks all : )

From: Mark_in_MO [#2]
29 Sep 2009
To: Lala (GTFOI) [#1] 29 Sep 2009

Lala,

If your morning Byetta shot is a breeze, and the evening Byetta shot is incapacitating, then what you are doing in addition to the evening shot may be the culprit. Metformin can cause stomach issues, and if you are taking two 1000mg pills at the same time in the afternoon, that may be part of your nausea issue. Check with your doctor and perhaps you could try to take the Metformin at 2 different times during the day, possibly one in the afternoon and the other at bedtime - this might reduce the evening meal nausea. Additionally, try eating immediately after taking the evening shot, usually the sooner you eat the less nausea you might have. You can also try to reduce the amount of food you are consuming for the evening meal, often it does not take very much food to feel full, and eating very little extra can produce the nausea you describe.

Taking one of your Metoformin pills in the evening may also help with the dawn effect. You can also try eating a few carbs before you go to bed, like a piece or two of dark chocolate, or a small handful of almonds - this could help with the dawn effect.

Check out the "Byetta Basics" on the START page, it has several suggestions for helping to manage nausea documented in a condensed format. Good luck, and let us know how you are doing.

From: Geri in Co:Byetta(3-06) (GERI) [#3]
29 Sep 2009
To: Lala (GTFOI) [#1] 29 Sep 2009

Mark has made some great suggestions so I can't add much more but I used the duct tape trick on my stomach and it worked. I don't care why it worked but it did. I also tried the sea bands and they helped with the lesser nausea. As Mark also suggested try eating less for dinner. Stop eating as soon as you are full, as Toneylee always says, not one bite more.

I try to eat a bigger breakfast, medium lunch, and a small dinner so I don't get sick after dinner. If I eat a big dinner I run the risk of getting sick so I eat a small dinner.

From: toneylee in VA (TONEYLEE) [#4]
29 Sep 2009
To: Lala (GTFOI) [#1] 29 Sep 2009

I agree with Mark and am especially suspicious of the metformin doses. Have you tested BGs when you are most nauseated? Also, try (for a while) testing before you inject your evening Byetta. Compare the 2 numbers. Were you high and then rapidly dropped? Or did you start out low and then go lower? Maybe neither. Maybe, since metformin causes gastrointestinal upset in at least half of all users, it is just too much meds in the evening.

Also, do you know that most people are told to take metformin with food to prevent nausea? Do you take it with no food?

From: Lala (GTFOI) [#5]
29 Sep 2009
To: ALL

Hi there--these are good suggestions. A couple of comments in answer to your posts:

I have noticed that the worse the nausea, the better my BS reading afterwards but haven't checked it during the symptoms--I'll do so tonight.

I have also noticed that if I eat a complex carb with the evening meal the nausea is more severe. I have been trying to incorporate a few of them into my diet after reading some posts here. Previously I was getting all carbs from veggies.

I have been on Metformin for about 5 months with no side effects so maybe it's interacting with the Byetta? Not sure. I will begin splitting up the dose though & taking it with food to see if that helps.

As to the dawn effect, I read here about taking a few carbs in at night before going to bed so I had 7 raw almonds last night & woke up this morning w/BS reading of 223 : (

Haven't read about the duct tape trick yet but look forward to many laughs from my husband if it works...

Thanks again for your help. I was getting desperate last night. I'll let you all know how it goes with the new advice. Keeping my fingers crossed!

From: toneylee in VA (TONEYLEE) [#6]
29 Sep 2009
To: Lala (GTFOI) [#5] 29 Sep 2009

Lala: You know, many vegetables (for example, beans, peas, sweet potatoes) ARE complex carbs. I wouldn't worry about the whole grains right now because they are harder to digest. Yes, many people have noticed that a minimum of about 30 carbs per Byetta meal seems to make for optimum benefit. But (and I can't believe I'm saying this) simple carbs seems ok to me right now while your nausea is so severe. I remember one advanced practice nurse here who ate and recommended those little Dole fruit cups in syrup for nausea. She didn't do it forever (or overdo it), but the sugar and simple carbs were easy on her stomach and helped her nausea. Other people sipped REAL Coke. Get over the nausea first and then concentrate on better nutrition and the complex carbs, at least in the evening.

On another note, I'm sorry the almonds didn't work for you. A snack doesn't help everyone. But maybe don't give up yet. Other suggestions include a small glass of red wine or one piece of dark chocolate. Hey, maybe you'll get lucky with what works! And then there are ExtendBars, which have improved fasting BGs for a lot of people.

Let us know and good luck! :)

From: Steve in FL (SKEET4ME) [#7]
3 Oct 2009
To: ALL

Hi Lala,

I use to experience much the same things you do. My doctor and I played a lot in the beginning to get my morning numbers down. Metformin early evening, late evening, bedtime, snacks here and there. We finally discovered that if I ate a full meal before bed I would wake up with numbers right at 100. Well you can guess the full meal at bedtime is a non-starter! :'-( So sometimes you just have to adjust to what gives you the best. Try some different stacks though, I found that some cheese and crackers at bedtime worked well for me.

I use to feel really bad a couple hours after my evening meals. Much like you the morning shot was easy. I don't know why the difference, but with me I found I was usually going low. Anyone here can tell you that I swear by ginger snaps, so in the evening when I felt bad I would test and then have a couple of ginger snaps. That fixed everything quickly, so you might try that. (nod)

Be patient because it gets better. I can pretty much eat anything I want now without feeling bad anymore.

From: Lala (GTFOI) [#8]
8 Oct 2009
To: Steve in FL (SKEET4ME) [#7] 8 Oct 2009

Wow, thanks for all the great advice. The ginger snaps are helping. You all rock! I'm still tweaking meds as my numbers are still too high (around 140 - 170 during the day & 200 - 230 in the morning). I feel like if I could just get the morning number down it would help all around. I started on Levemir (12 hr insulin) at night but so far it has only helped for the first 3 days or so. On the days when my morning numbers were lower (around 140) the rest of my day's numbers would be perfect.

So ok, I know it's a process & I'm working on it, just like everybody else has to : ) I'm also trying to focus on nutrition as well, as opposed to just getting the right number of carbs, etc. I find that I just feel better when I eat food that is less processed, but honestly it's a bit challenging to run a business, take care of family & parents, & be aware of every single thing I eat at the same time. Where's a healthy drive thru when you're running out of time? (just kidding). Anyway, thanks again for all your help.

From: Jan (JANICE) [#9]
7 Nov 2009
To: Lala (GTFOI) [#8] 7 Nov 2009

Lala:

I had to tweak when I take my metiformin in order to reduce stomach upset.

This has worked for me - I do my Byetta shot before breakfast, no other meds for 2 hours. I take my first metiformin with lunch.

Second Byetta at dinner. Second metiformin dose at bedtime with a snack.

This has done two things for me - reduced stomach upset and reduced mid afternoon bg high readings.

From: Lala (GTFOI) [#10]
7 Nov 2009
To: ALL

Wow, I'm going to try it. Thankfully, the evening nausea is not as bad as it was, but it's still pretty bad, so thank you for the advice : )

From: Aurora (AURORAMARIE) [#11]
8 Nov 2009
To: ALL

Thanks for the advice Jan,
The 5 is working, but its not enough, so I'll probably be one of the ones on 10 within a month.
My morning fasting BS is averaging about 220. It was averaging 220 before Byetta, but I was on januvia and 25 more units of insulin than I am now, so the Byetta just replaced the other meds as far as I can tell, except instead of gaining weight, I seem to be losing, so thats a definate plus.
Yesterday after Byetta, a 30 carb lunch and a TWO hour walk, my BS was 253, I was so dissappointed. :(
I was diagnosed with type 2 last October, so 13 months, and have been on Actos, Metformin, Januvia, Lantus, lexar? (the other basil insulin pen forgot the name) and Byetta, and have not had a threat of going low, my lowest BS ever was 136 and that was after a 2 1/2 hour walk, usually it stays over 200 ALL the time, no matter if I eat no carbs and excercise all day lone, so I am kind of getting discouraged and feeling desperate.

From: Geri in Co:Byetta(3-06) (GERI) [#12]
8 Nov 2009
To: Aurora (AURORAMARIE) [#11] 8 Nov 2009

Have you seen a nutritionist? Do you eat simple carbs? I like to say that Byetta is a tool and we need to work with it, some of us, you and me, need to work harder than others. Maybe be more patient to let things work. For some of us Byetta doesn't work really good until 5-6 mos have passed.

As far as exercise goes, do you eat a complex carb with a protein before you start your walks? If you exercise for that long you may need to eat either before or during the walk. Your liver may be dumping alot of glucose during your walk because your numbers went too low during the walk. See if this helps. Oh and have you tested 1-2 hrs after walking to see what your glucose levels are?

From: Aurora (AURORAMARIE) [#13]
8 Nov 2009
To: Geri in Co:Byetta(3-06) (GERI) [#12] 8 Nov 2009

Thanks for the advice Geri,
No I haven't seen a nutritionist, I haven't had much luck finding one in my area that accepts my insurance and is accepting new clients, I'm also looking for an endo in my area with no luck. Admittedly I have been letting my diet go more and more since nothing I do seems to effect my #s, but I do stay fairly healthy, I don't eat quick carbs or fast sugars normally. As far as taking my blood sugar, a few hours after the walk, I didn't but I took it after dinner and it was 273. So I got the feeling it didn't go down at all.
This morning though it was 181 and after breakfast (2 hours) it was 171, so these #s are very promising.
I'm gonna try taking it a couple of hours after my walk today (although it will only be a 30 min walk today/

From: Geri in Co:Byetta(3-06) (GERI) [#14]
8 Nov 2009
To: Aurora (AURORAMARIE) [#13] 9 Nov 2009

If the numbers are coming down slowly that's good. If they come down too fast thats when we get real sick so slowly is better. Hope things get better slowly. Test 2 hrs after eating then again 3 or 4. That will help you to see how Byetta is helping you.

We have a shortage of endos here in the Denver Metro area and maybe across the country. Have you asked your current dr for a referral? You might be able to call the local hospital and ask them for a referral too.

Hang in there and be positive that Byetta is going to work for you.

From: Julie (SHEBAML) [#15]
9 Nov 2009
To: Geri in Co:Byetta(3-06) (GERI) [#3] 9 Nov 2009

I have been on Byetta for three years, lost more than 50 pounds and my BG is wonderfully controlled on Byetta - generally post-dinner readings under 100 and an A1c of 5.3.

I had initial nausea and then twice, my endocrinologist had me try the 10 mcg rather than the initial 5 mcg. My body couldn't tolerate it and even with Compazine, I was getting nauseous and vomiting. I returned to 5 mcg and it work well.

I also found that mint sugar free candy helped cut the nausea and, of course, avoiding fatty foods.

Hope it works for you.

From: Jan (JANICE) [#16]
14 Nov 2009
To: ALL

Aurora:

Keep trying - everyone is different and it takes some people's bodies a bit longer to adjust and see results.

Even though I got fairly good control right away on Byetta I had some set-backs now and then with afternoon numbers going into the 200's for no apparent reason. I know, it is depressing and fustrating.

For me, I changed when I took my metiformin, from breakfast to lunch and that helped the afternoon highs.

I do find that even just what might seem as a little cheating food-wise can cause some nasty high numbers. Problem is that sometimes it doesn't and then we are fooled into thinking we can do it more than we should.

From: Aurora (AURORAMARIE) [#17]
15 Nov 2009
To: Jan (JANICE) [#16] 17 Nov 2009

Yeah, I like to save that for an excuse when i want to eat something crazy. "My numbers don't make any sense anyway, and I had that turkey sandwhich on whole grain bread and then took a walk and got a 260 reading, so I might as well just eat the cheesburger, because my # will be the same either way!" I know I'm just fooling myself, but sometimes when you want something not good for you, it seems to make sense. KWIM?

From: Sue (SUEFIRST50) [#18]
15 Nov 2009
To: Aurora (AURORAMARIE) [#17] 15 Nov 2009

Some people find their numbers go up after exercise instead of down so that might be the problem. Also the bread might be the kind that has a lot of carbs even if it has grains. I think you are like many of us who do not find consistancy in how eating and exercise affects us. It can be quite frustrating and discouraging as we know all know. Just do the best you can and hope things kick into gear.

From: Webe (WENDY) [#19]
17 Nov 2009
To: ALL

My nausea is still there, not horrible most of the time but the other night I was sitting by the porcelain alter again. My problem is I am afraid to eat. The bad night, I had made some mac and cheese for dinner and could only eat a few bites before it made me feel horrible. I had a clementine and felt better. It was several hours later that I was sick. Lately I have had to make myself eat anything at all. And I sure as heck don't feel like cooking anything! My daughter made some package potatoes last night and the smell set me to gagging. I am determined to stick to Byetta because I have lost almost 20 pounds since starting in Sept. At what point should I add a multi vitamin? If I am eating 800 calories a day, it's a good day.

From: Geri in Co:Byetta(3-06) (GERI) [#20]
17 Nov 2009
To: Webe (WENDY) [#19] 18 Nov 2009

The eating of a clementine and you feeling better for awhile indicates to me you are going too low for you. Are you testing your glucose levels when you are sick? How about trying to stay away from processed foods like mac & cheese/packaged potatoes. Try eating simply for awhile. Things like a piece of meat, lots of veggies, and maybe a sweet potato/brown rice/quinoa, buckwheat. Stuff like that. By eating alot of veggies you will be eating more alkaline producing foods and you may start preventing some of the nausea without taking another pill. Use Byetta as a tool to help you change your lifestyle not as another medicine so you can continue on as usual. Changing our thinking about meds will help us for our lifetime and not for the shorttime.

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