Diabetes Self-Management Blog

Last week, we looked at a few prescription weight-loss drugs—some that can lead to dependency, and one that has yet to be approved. What else is available? If you’ve been in your local pharmacy recently, you may have seen displays heralding the arrival of "alli" (spelled with a small "a" and pronounced "ally"). What’s this all about, and why is it sold over the counter rather than by prescription?

You may recall the advent of Xenical (orlistat) almost 10 years ago. Xenical is a different kind of weight-loss drug in that it works on the gastrointestinal (GI) tract, and not on the appetite center in the brain. Specifically, Xenical prevents about one-third of the fat a person eats from being absorbed. And we all know that fat is a concentrated source of calories, so by preventing some of it from being digested and absorbed, people using Xenical end up taking in fewer calories and losing weight. What happens to the fat? The person eliminates it. Unfortunately, there are some rather unpleasant side effects, including an increased number of bowel movements, increased urgency, gas with oily discharge, and anal leakage. These symptoms are more likely to occur if the user’s fat intake exceeds more than 30% of his calories; therefore, there’s a kind of negative reinforcement that comes along with using this drug. In addition, Xenical can prevent the absorption of some fat-soluble vitamins, so it’s recommended that a person take a multivitamin while using this medicine. Xenical is taken as a 120-milligram capsule, up to three times per day.

The newer drug alli is Xenical’s lower-dose cousin. It works exactly the same way, by blocking some fat absorption, and the side effects are the same. In fact, alli’s Web site, www.myalli.com, nicely describes this undigested fat appearing in your toilet as looking like “the oil on top of a pizza.” Hmmm.

alli is taken as a 60-milligram capsule up to three times per day. The expectation is that a person will also follow a low-fat eating plan while taking alli; therefore, for every five pounds he loses on the low-fat diet, alli can help him lose an extra two to three pounds. Most of the weight lost while taking alli will occur during the first six months. Fortunately, alli’s Web site recommends working with a registered dietitian for safe and effective weight loss, which is always sage advice.

Not sure if alli is for you? Well, if you have Type 2 diabetes and are taking metformin, a sulfonylurea, a thiazolidinedione (rosiglitazone [brand name Avandia] or pioglitazone [Actos]), or any combination of these drugs, you might talk to your physician about taking Byetta (exenatide). Byetta is a newer type of drug called an incretin mimetic that can help improve blood glucose control. Interestingly, it’s derived from the saliva of a lizard called the Gila monster. It’s not approved for use in people with Type 1 diabetes.

Byetta works to control fasting and post-meal blood glucose levels by restoring first-phase insulin secretion and suppressing glucagon secretion (glucagon is a hormone that raises blood glucose levels). Byetta also slows gastric emptying, which means that it can suppress appetite and lead to weight loss, which has been quite significant in many people. And it’s been shown to lower triglyceride levels and raise HDL (or “good”) cholesterol levels, as well. Side effects of Byetta include nausea, which is usually temporary, and possibly hypoglycemia if it is taken along with a sulfonylurea. Also, Byetta is given as an injection (just like insulin), using a pen device. For more information, check out www.byetta.com.

So, no magic weight loss pill (or injection) is available yet. However, more and more options are becoming available. If you’re interested in any of these medicines, talk to your health-care team about the best option for you.


  1. This topic hits a sensitive spot with me. I was diagnosed at the end of December (at the time my weight was 185 lbs BMI of 35). By the end of January, I was down to 160, BMI 31, where I remain. I believe much of the loss that first month was due to the gastrointestinal distress of beginning Avandamet. Also, I was given no info other than “stay away from carbs”. So, I basically began my own version of Atkins and cut my carbs to about 30g per day, keeping daily calories between 800-900. I eat no bread, pasta, potatoes, rice, etc. All carbs come from the fruits and veggies I eat. I walk 2 miles 3 times a week. I would exercise more, but I am extremely tired all the time and have had dizzy spells when I try. My glucose is still above where it should be 130+ fasting, 200+ post-meal. I can’t lose anymore weight on my own. I’m afraid to cut any more calories or increase activity. Without pharmaceutical help, how can someone like me lose weight? People assume I deserve being fat and sick.

    Posted by 33-yr-old Type 2 Female |
  2. Hi,

    First, congratulations for getting your weight and your BMI down. That’s no small feat! Unfortunately, the advice you recieved to “stay away from carbs” wasn’t helpful or practical. Second, trying to limit your carbs to 30 g per day and calories to 900 per day isn’t very realistic or healthy. No wonder you’re feeling fatigued and dizzy! I strongly suggest you make an appointment with a dietitian. Ask your doctor for a referral. You need more guidance in terms of how many calories and grams of carb that are right for you. You actually may need to take in more calories in order to lose weight, believe it or not. Also, while you’re doing a great job with your walking, for weight loss, you’ll need to aim for being active at least 5 days a week, if not every day, so gradually work your way up. Consider joining a program such as Weight Watchers for support. Finally, talk to your doctor about your blood glucose levels and if weight loss medication is right for you. Best of luck!

    Posted by acampbell |
  3. I don’t have diabetes but I’m 5′2 and 200 lbs - BMI 38!!

    Doc has prescribed Byetta, but I tire of the shots. I’m wondering if a combination of Byetta and Alli is safe?


    Posted by dnewman |
  4. Hi dnewman,

    Is the Byetta working for you? Interestingly, Byetta hasn’t been approved for use in people without diabetes, or specifically for weight loss purposes. However, many physicians are using it “off-label”. Byetta is safe to use with alli. But remember, with alli, you need to be following a low fat eating plan; otherwise, you’ll experience some unpleasant gastrointestinal side effects. If you’re not certain if Byetta is for you, have you considered either working with a dietitian or joining a commercial weight loss program, such as Weight Watchers or Jenny Craig? There may come a time when you decide you don’t want to stay on either or both Byetta and alli, so you’ll want to make sure you have an understanding of healthy food choices and portion control. Good luck!

    Posted by acampbell |
  5. If taking Byetta with Alli when do you take what. Does it matter which you take first? Will the slowing down of gastric emptying by the Byetta cause a problem with ALLI?

    Posted by Lisa |
  6. Hi Lisa,

    I asked our pharmacist your questions. Here’s what she said: Byetta should be injected 30–60 minutes before you start eating breakfast and supper. Alli is taken during or up to one hour after eating. So, the order is: Byetta first, Alli second. There shouldn’t be a problem with taking these two drugs together in terms of gastric emptying. However, let your physician know if you have any gastrointestinal symptoms while taking these.

    Posted by acampbell |
  7. Hi, my question has already been asked but I will ask it anyway. I have been taking byetta for about four months now and first was on a 5m does now up to 10. I still feel sick on this drug and my bowel movements are terrible. I want to know if you think it safe to take xenical with this drug as xenical worked for me before but byetta has not helped me to loose weight as when I feel sick I tend to eat and the feeling goes away but returns about half an hour after I have eaten and so I am fighting a losing battle. I do have type 2 diabetes.

    Posted by Joyce |
  8. Hi Joyce,
    I’m sorry to hear that you’re feeling sick. I’m certainly not a doctor or pharmacist, but it sounds like starting to take Xenical at this point may not be the best idea, since you already have GI symptoms. I’d suggest working with your physician first to deal with your Byetta symptoms and decide if that’s the best choice for you.

    Posted by acampbell |
  9. Hello im a diabece and would like to take alli to loss weight would it be safe to take with all my med thank you LINDA

    Posted by LINDA |
  10. Hi Linda,

    Without knowing which medicines you’re taking, it’s hard to say. To be on the safe side, please call your doctor to make sure that it’s OK to take alli.

    Posted by acampbell |
  11. Thank you for sharing your experience.
    To be safe, I recommend controling diet rather than taking medicines.
    Life style changes such as eating healthfully and exercising can be the most effective way to reduce percent body fat, thus eliminating one of the potential risk factors. Surprisingly, successful lifestyle changes frequently eliminate the need for medications.

    Posted by Yuki Sato |
  12. Is it safe to take Byetta with achalasia?

    Posted by Beverly Cawby |
  13. Hi Beverly,

    I’m afraid I don’t know enough about achalasia to answer your question. You should check with your doctor or gastroenterologist about this.

    Posted by acampbell |
  14. I am wondering if it is safe to take Byetta during the Atkins induction phase. I can’t seem to find anything online regarding this. Thank you.

    Posted by Shannon |
  15. Hi Shannon,

    Guidelines on Byetta’s Web site say to take Byetta with your two main meals of the day. Because Byetta is a glucose-dependent medicine, it’s unlikely that taking this drug with a meal that contains very little carbohydrate (such as an Atkins meals) will give you any benefit. If you are on the Atkins diet (or any kind of low-carb diet where you’re eating less than 30 grams of carbohydrate at a meal), talk to your provider about whether you should take Byetta.

    Posted by acampbell |
  16. I was diagnoised with type 2 diabetes 3 mo ago at age of 57 and sugar at 800. I am now taking 3 dif kinds of insulin and was feeling so tired all the time and couldnt hardly get out of bed. I people will laugh about this but I came across a partial bottle my mother had of geritol vitamins, so I started taking them. within one week time, my energy level was back like it should be and and I was feeling great. I know the are an old vitamin but they work. People had told me if u are diabetic you just learn to live with tiredness, but you have have to live with it!

    Posted by Connie Scarberry |

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