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Our aim is to streamline an integrated network of services already available and bring other services currently only available in Melbourne, locally. We link families to a wide referral base while also developing, wellbeing events such as; Family Camp, Peer Support, Siblings Day, Raising Community awareness and Education within our schools. BYETTA is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus [see Clinical Studies (14)]. The concurrent use of BYETTA with prandial insulin has not been studied and cannot be recommended.
Based on postmarketing data BYETTA has been associated with acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis. BYETTA should be initiated at 5 mcg administered twice daily (BID) at any time within the 60-minute period before the morning and evening meals (or before the two main meals of the day, approximately 6 hours or more apart). BYETTA is contraindicated in patients with prior severe hypersensitivity reactions to exenatide or to any of the product components.
Based on postmarketing data, BYETTA has been associated with acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis. The risk of hypoglycemia is increased when BYETTA is used in combination with a sulfonylurea. BYETTA should not be used in patients with severe renal impairment (creatinine clearance  Use in Specific Populations (8.6)]. There have been postmarketing reports of altered renal function, including increased serum creatinine, renal impairment, worsened chronic renal failure and acute renal failure, sometimes requiring hemodialysis or kidney transplantation.
BYETTA has not been studied in patients with severe gastrointestinal disease, including gastroparesis.
There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with BYETTA or any other antidiabetic drug. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Table 1 summarizes the incidence and rate of hypoglycemia with BYETTA in six placebo-controlled clinical trials. Antibodies were assessed in 90% of subjects in the 30-week, 24-week, and 16-week studies of BYETTA. In the 16-week trial of BYETTA add-on to thiazolidinediones, with or without metformin, 36 patients (31%) had low titer antibodies to exenatide at 16 weeks. In the 24-week trial of BYETTA used as monotherapy, 40 patients (28%) had low titer antibodies to exenatide at 24 weeks. Antibodies to exenatide were not assessed in the 30-week trial of BYETTA used in combination with insulin glargine.
For the 24-week placebo-controlled study of BYETTA used as a monotherapy, Table 2 summarizes adverse reactions (excluding hypoglycemia) occurring with an incidence ?2% and occurring more frequently in BYETTA-treated patients compared with placebo-treated patients. Two of the 155 patients treated with BYETTA withdrew due to adverse reactions of headache and nausea.
The most common adverse reactions leading to withdrawal for BYETTA-treated patients were nausea (3% of patients) and vomiting (1%). For the 16-week placebo-controlled study of BYETTA add-on to a thiazolidinedione, with or without metformin, Table 4 summarizes the adverse reactions (excluding hypoglycemia) with an incidence of ?2% and occurring more frequently in BYETTA-treated patients compared with placebo-treated patients.
The most common adverse reactions leading to withdrawal for BYETTA-treated patients were nausea (9%) and vomiting (5%). For the 30-week placebo-controlled study of BYETTA as add-on to insulin glargine with or without oral antihyperglycemic medications, Table 5 summarizes adverse reactions (excluding hypoglycemia) occurring with an incidence ?2% and occurring more frequently in BYETTA-treated patients compared with placebo-treated patients. The following additional adverse reactions have been reported during postapproval use of BYETTA.
The effect of BYETTA to slow gastric emptying can reduce the extent and rate of absorption of orally administered drugs. There are postmarketing reports of increased INR sometimes associated with bleeding, with concomitant use of warfarin and BYETTA [see Adverse Reactions (6.2)]. In developmental toxicity studies, pregnant animals received exenatide subcutaneously during organogenesis. A Pregnancy Registry has been implemented to monitor pregnancy outcomes of women exposed to exenatide during pregnancy.
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The DASH diet, Dietary Approaches to Stop Hypertension is currently recommended by the American Heart Association. A 2008 study in the Archives of Internal Medicine found that among 88,517 women who were followed for 24 years, the DASH diet was associated with a lower risk of coronary heart disease and stroke in middle age.
The 22-person volunteer panel that chose the diets included Brian Wansink of the Cornell University Food and Brand lab, Dr.
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The blood sugar level test can be given in various different ways such drinking pure glucose.
For most people hearing those dreaded words that they need to come in for a blood sugar level test is a hard thing to stomach but it has to be done in order to keep them safe, healthy and happy as well as to be able to live a long and healthy lifestyle. When my grandmother was first diagnosed with diabetes many years ago, it was just a simple life changing habit of changing up some foods and diet and then knowing that she needed to monitor her sugar several times a day.


So far this winter, we’ve tried to give you a good overview of the many things to keep in mind in regards to your feet: the right winter shoes, winter fitness options, winter running, cold weather nutrition and maintaining healthy winter feet. This risk is heightened as a growing number of people participate in the wide variety of winter sports, from skiing and snowboarding to ice hockey and figure skating. More common in people with poor circulation, chilblains (pictured above) occur when the skin is exposed to cold humid and then is introduced quickly to a warm environment. Chilblains are often found on the toes and, more specifically, on bunions and calluses, where there is more pressure on the foot.
If you think you have a chilblain, you can use an anti-itch lotion but, like doctors always say, don’t give in to the itch. Named for a French doctor, this disorder sounds more like an astronomical event than a medical condition affecting blood vessels (or at least it does to us).
If you look down at your feet and see a black toenail looking back up at you, you might have skier’s toe. One-time trauma or repetitive use of too-tight shoes (especially ski boots, hence the name) can cause this condition.
Like skier’s toe, Morton’s neuromas are caused by too-tight footwear, which squeezes the tissue and bones against nerves.
Your feet get wider as you age, so make sure to check your foot size (and width) every winter.
Well-fitting and quality-made winter shoes help keep your feet free of these pesky skins bubbles. SHOES-n-FEET’s unique combination of retail, education and service has "closed the loop" between the medical community, their patients, and retail shoe stores and is a win-win for everyone.
Recent figures show that 41 of Victoria's 79 local government areas are now considered diabetes 'hotspots'.
BYETTA should not be used for the treatment of type 1 diabetes or diabetic ketoacidosis, as it would not be effective in these settings.
After initiation of BYETTA, and after dose increases, observe patients carefully for signs and symptoms of pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back, which may or may not be accompanied by vomiting).
Therefore, patients receiving BYETTA and a sulfonylurea may require a lower dose of the sulfonylurea to reduce the risk of hypoglycemia. In patients at increased risk of hypoglycemia consider reducing the dose of insulin [see Adverse Reactions (6.1)].
In patients with end-stage renal disease receiving dialysis, single doses of BYETTA 5 mcg were not well tolerated due to gastrointestinal side effects. Some of these events occurred in patients receiving one or more pharmacologic agents known to affect renal function or hydration status, such as angiotensin converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, or diuretics. Because BYETTA is commonly associated with gastrointestinal adverse reactions, including nausea, vomiting, and diarrhea, the use of BYETTA is not recommended in patients with severe gastrointestinal disease.
Antibody levels were measured in 90% of subjects in the 30-week, 24-week, and 16-week studies of BYETTA. If a hypersensitivity reaction occurs, the patient should discontinue BYETTA and other suspect medications and promptly seek medical advice [see Adverse Reactions (6.2)]. Severe hypoglycemia was defined as an event with symptoms consistent with hypoglycemia requiring the assistance of another person and associated with either a blood glucose value consistent with hypoglycemia or prompt recovery after treatment for hypoglycemia.
The level of glycemic control in these patients was generally comparable to that observed in the 69 patients (60%) without antibody titer. The level of glycemic control in these patients was generally comparable to that observed in the 101 patients (70%) without antibody titers. Because these events are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
BYETTA should be used with caution in patients receiving oral medications that have narrow therapeutic index or require rapid gastrointestinal absorption [see Adverse Reactions (6.2)].
In animal studies, exenatide caused cleft palate, irregular skeletal ossification and an increased number of neonatal deaths. A lot of times your doctor will have you come into the office fasting and then ask you to drink a small bottle of pure glucose which is basically sugar water within a certain period of time and then you will be asked to either give a urine sample or a blood sample so that they can test your blood glucose level in order to see if you are a diabetic or not. Diabetes is caused by insufficient insulin production or lack of responsiveness to insulin, resulting in hyperglycemia (high blood glucose levels). When I have asked her about her trials and tribulations that she has gone through she said that the worst news she got was having her come in for a blood sugar level test which would let her know if she was a full blown diabetic or not.
Avoid spending the rest of winter off your feet by learning about these conditions and how to prevent and treat them. The cold air first constricts the small blood vessels in the skin; if the skin gets hot too quickly, the blood vessels cannot react properly in time. You can lessen your risk of chilblains by keeping your feet warm at all times and by avoiding the use of direct heat. Like we saw above, very cold temperatures cause small blood vessels to tighten, limiting circulation towards the extremities, which are already at a disadvantage for being so far from the body’s core.
If you will be spending an extended period of time outdoors keep extremities covered and be aware of the look and feel of your skin. The dark color you see is caused by bleeding under the nail (known medically as a “subungual hematoma”), and the painful pulsing you feel is due to the pressure of the blood against your nail.
So it is important that your winter sports footwear allows you proper roominess in the toe box.


The sooner you get it looked at, the easier it will be to treat by relieving the pressure behind the nail. But friction reigns from time to time, and repeated rubbing may cause blisters to develop, especially if you’re breaking in new shoes (though, if you’re getting shoes fitted properly by a professional, you shouldn’t really have to “break them in” to begin with). Do you have existing foot health conditions that require you to take extra precautions, especially during extreme winter weather?
Our “Be You” Couch to 5K Training Program is jam packed with training, education and strategies to help make your 5K a success! It is unknown whether patients with a history of pancreatitis are at increased risk for pancreatitis while using BYETTA. Based on clinical response, the dose of BYETTA can be increased to 10 mcg twice daily after 1 month of therapy.
If pancreatitis is suspected, BYETTA should promptly be discontinued and appropriate management should be initiated. Because BYETTA may induce nausea and vomiting with transient hypovolemia, treatment may worsen renal function. Some events occurred in patients who had been experiencing nausea, vomiting, or diarrhea, with or without dehydration. In 3%, 4%, and 1% of these patients, respectively, antibody formation was associated with an attenuated glycemic response.
For oral medications that are dependent on threshold concentrations for efficacy, such as contraceptives and antibiotics, patients should be advised to take those drugs at least 1 hour before BYETTA injection. Once a stable prothrombin time has been documented, prothrombin times can be monitored at the intervals usually recommended for patients on warfarin. BYETTA should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. News and World Report added diets to its suite of rankings and the panel has named the DASH diet the best overall diet of 2012.
If this sounds like you then chances are you have been faced with the dreaded blood sugar level test. There are 2 primary types of diabetes mellitus, type I (insulin-dependent or juvenile-onset), which may be caused by an autoimmune response, and type II (non-insulin-dependent or adult-onset).
Blood then leaks into the tissue, resulting in itchy, red and, at times swollen, spots on the skin. Let your feet warm up slowly so that your circulation can respond to the change in temperature in a healthy way. If you suffer from diabetes or have circulatory issues, see your podiatrist to minimize risks. If your skin is turning white, get indoors and warm the area slowly until it returns to normal color. Make sure your socks fit tightly all around your foot – we don’t want anything putting additional pressure inside the front of your boots. This painful “electric toe” is most common around the third toe, but can happen in other parts of the foot. Stop by a SHOES-n-FEET store today to speak to a Certified Shoe Fitter or email Ask the Shoe Fitter!
Other antidiabetic therapies should be considered in patients with a history of pancreatitis.
Reversibility of altered renal function has been observed in many cases with supportive treatment and discontinuation of potentially causative agents, including BYETTA. If there is worsening glycemic control or failure to achieve targeted glycemic control, alternative antidiabetic therapy should be considered [see Adverse Reactions (6.1)]. Three hundred and sixty patients (38%) had low titer antibodies (Warnings and Precautions (5.5)].
If such drugs are to be administered with food, patients should be advised to take them with a meal or snack when BYETTA is not administered [see Clinical Pharmacology (12.3)].
The rankings were chosen based on information from sources such as government reports and scientific journals.
Each dose should be administered as a subcutaneous (SC) injection in the thigh, abdomen, or upper arm. Consider antidiabetic therapies other than BYETTA in patients with a history of pancreatitis. Exenatide has not been found to be directly nephrotoxic in preclinical or clinical studies.
The DASH may also help lower cholesterol, as it’s big on whole grains, fruits, vegetables and lean proteins. If it opens, put a topical antiseptic to avoid infection (and a trip to the podiatric clinic). No data are available on the safety or efficacy of intravenous or intramuscular injection of BYETTA.



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