People with diabetes 2 have beta cell dysfunction, the cells that make and release insulin, and a decreased beta cell mass due to apoptosis – death of beta cells. This has highlighted the role of incretin hormones GIP and GLP-1 in beta cell function, growth and development.

The incretins are peptide hormones secreted by specific cells located in the small intestine in response to food intake. In the pancreas, incretin hormones act to increase glucose-dependent insulin secretion from beta cells and are essential for maintaining after meal glucose control.

There are observations to be noted in people with diabetes 2 before any diagnosis of an abnormal glucose is made. The disorder begins far sooner than the abnormal glucose indicates.

• The rapid release of insulin is completely absent at the time of diagnosis of diabetes 2.
• Total beta cell function and mass is half normal at time of diagnosis.

The remainder of the natural history of diabetes 2 is now well understood.

• Total beta cells, beta cell mass in people with diabetes 2, decreases linearly for the first 10 years if no intervention occurs.
• L-arginine still produces insulin response during this time.
• Glyburide and other sulfonylureas also produce a normal insulin response.

Apoptosis occurs at an increased rate in this stage of diabetes 2. There are treatments used to treat the high glucose that can decrease the life of the beta cell. These medications include the following.

• Starlix, Prandin and Glyburide
Byetta, fondly referred to as “lizard spit”, seems to reverse all of these negative diabetes 2 processes and treatments quite handily. It is quite similar to GLP-1 having been altered slightly to be able to patent the molecule. There are other unique features that make it quite safe. It acts to,
• Increase first phase insulin response
• Increase late phase and total insulin production.
• It inhibits glucagon release
• It lowers its power as glucose goes to normal thus decreasing the chance of hypoglycemia.

Additionally it increases important regulation of beta cell gene expression for the following.

• Glukinase – aids release of glycogen from liver
• Insulin production
• Glucose transporters – decreasing insulin resistance

Finally, Byetta will increase beta cell mass through replication of beta cell and decreased apoptosis.

It appears that Byetta will reverse the natural decline of the Islands of Langerhans where the beta cells reside and add a few more things that give the reversal a “soft landing” that makes it quite safe. The decrease in apoptosis and increase in beta cell mass mark this product as an exceptional advance in the care of patients with diabetes 2. We now are using Byetta in many people with type 1 with very good preliminary results.

This doesn’t even take into consideration the intangibles such as decreased fatigue, increased muscle strength and diminished abdominal fat patients love perhaps most of all.