Byetta Vs. Insulin: Drug Comparison

Byetta^® (exenatide) is a glucagon-like peptide-1 (GLP-1) receptor agonist used to improve blood sugar control in adults with type 2 diabetes by enhancing insulin secretion, slowing stomach emptying, and reducing glucagon release. Its FDA-approved indication is for the treatment of type 2 diabetes, typically alongside diet and exercise. It is not approved for use in type 1 diabetes or diabetic ketoacidosis. Byetta is available as a twice-daily injectable solution. Most common side effects include nausea, low blood sugar, vomiting, diarrhea, feeling jittery, dizziness, headache, indigestion, constipation, and weakness. Nausea usually decreases over time. Byetta has been associated with a risk of pancreatitis and should be used cautiously with other medications that affect blood sugar levels.

Insulin is a vital hormone produced by the pancreas that regulates blood sugar levels by facilitating the uptake of glucose into cells for energy production. It is essential for individuals with type 1 diabetes, who cannot produce insulin naturally, and is also used in some cases of type 2 diabetes to help control blood glucose levels when other medications are insufficient. Insulin therapy involves the administration of synthetic or animal-derived insulin, through injections or insulin pumps, and requires careful monitoring to balance blood sugar levels and avoid low blood sugar. Side effects can include low blood sugar, weight gain, and, in some cases, allergic reactions at the injection site​.

Insulin has many different types and names. The information below is about brand name Humalog^®, which is a type of insulin lispro (a rapid-acting insulin).

Glucagon-like peptide-1 (GLP-1) receptor agonist

Rapid acting human insulin analog

Byetta (exenatide) is indicated:

• As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus

Humalog (insulin lispro) is indicated:

• To improve glycemic control in adult and pediatric patients with diabetes mellitus

• Typically taken as an injection twice daily

• Comes in single-patient-use prefilled pens that deliver 5 mcg or 10 mcg per dose

• See the Full Prescribing Information for important administration instructions

• Comes as an injection

Most common (≥5%) and occurring more frequently than placebo in clinical trials:

• Nausea (usually decreases over time)

• Low blood sugar

• Vomiting

• Diarrhea

• Feeling jittery

• Dizziness

• Headache

• Indigestion

• Constipation

• Weakness

Postmarketing reports with exenatide of increased international normalized ratio (INR) with concomitant use of warfarin, sometimes with bleeding

Adverse reactions associated with Humalog include:

• Low blood sugar

• Allergic reactions

• Injection site reactions

• Abnormal distribution of fat

• Itch

• Rash

• History of severe hypersensitivity to exenatide or any of the excipients in Byetta

• History of drug-induced immune-mediated thrombocytopenia from exenatide products

• Drug interactions: orally administered medications, warfarin

• Do not use during episodes of low blood sugar

• Do not use in patients with hypersensitivity to insulin lispro or any of the excipients in Humalog

• Drug interactions: Drugs that may increase the risk of low blood sugar (antidiabetic agents, ACE inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, salicylates, somatostatin analog [e.g., octreotide], sulfonamide antibiotics), drugs that may decrease the blood glucose lowering effect (atypical antipsychotics, corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens [e.g., in oral contraceptives], protease inhibitors, somatropin, sympathomimetic agents [e.g., albuterol, epinephrine, terbutaline], thyroid hormones), drugs that may increase or decrease the blood glucose lowering effect (alcohol, beta-blockers, clonidine, lithium salts, pentamidine), drugs that may blunt the signs and symptoms of low blood sugar (beta-blockers, clonidine, guanethidine, reserpine)

• Never share a Byetta pen between patients, even if the needle is changed

• Acute pancreatitis

• Low blood sugar with concomitant use of insulin secretagogues or insulin

• Acute kidney injury

• Severe gastrointestinal disease

• Immunogenicity: Patients may develop antibodies to exenatide

• Hypersensitivity

• Drug-induced immune-mediated thrombocytopenia

• Acute gallbladder disease

• Never share a Humalog prefilled pen, cartridge, reusable pen compatible with Lilly 3 mL cartridges, or syringe between patients, even if the needle is changed

• High blood sugar or low blood sugar with changes in insulin regimen

• Low blood sugar: May be life-threatening

• Low blood sugar due to medication errors

• Hypersensitivity reactions: May be life-threatening

• Hypokalemia: May be life-threatening

• Fluid retention and heart failure with concomitant use of thiazolidinediones (TZDs)

• High blood sugar and ketoacidosis due to insulin pump device malfunction

*This information is from the label for brand name Byetta^®. See the Full Prescribing Information for more complete information. Exenatide, the active ingredient in Byetta, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient exenatide.

*This information is from the label for brand name Humalog^®, which is a type of insulin lispro (a rapid-acting insulin). See the Full Prescribing Information for more complete information. Insulin has many different types and names, and this information may not be accurate for all medications that include insulin.