Byetta for weight loss or people on insulin

I recently received questions about using Byetta combined with insulin, and using Byetta for weight control when a person ahs well-controlled diabetes. Here is my response.

I'll start with the Amylin company position that Byetta is not FDA approved for use with insulin.

I have dozens of patients on insulin and Byetta, most commonly for weight loss and improved control. People well-controlled on small doses of insulin sometimes get off the insulin. A patient with an A1c of 7 but gaining weight would benefit from Byetta; I would be inclined to cut the insulin in half, and if on 20 units/d or less stop it when starting Byetta. They need to know that they may need to go back up on the insulin dose or restart it if the Byetta doesn't quiet control things.

I've also added Byetta or switched people to Byetta who are well controlled on oral agents but struggling with weight. As long as the A1c is >6.5 it should be covered by insurance. If they're on a weight-gaining medication such as sulfonylurea, Actos or Avandia I would reduce or stop them while adding Byetta.

Don't change or stop any of your medications based on the above information. Only make medication changes by working with your treating physician.