Been a week Januvia may be pittering out - BGs creeping back up

Continuing the discussion from Update Endo #3 Starting me with Januvia samples:

O.k. my morning fasting levels are good each morning usually around 89 - 98, compared to previous BGs of 125-145. My lunch and evening numbers preprandial were holding steady at 101 - 111 but now they are creeping closer to 120s - 130s and my postprandials are beginning to climb back to their old ways from 101 - 118 to 147 - 167. It’s been a week and I’m still doing a low carb diet and stretching exercises.

When I go to the bathroom my urine smells like strong, sweet syrup, but I haven’t checked for ketones. Should I be checking for ketones? Is that even necessary since: 1) my numbers are not over 200 and 2) the doctors have ruled my diabetes is steroid induced (classified in the category of T2)? I am still drinking a lot of water and still traveling a lot to the restroom (day and night).

I don’t see the endo again until August 26th. I’m not sure if I have enough samples to last until then. She didn’t give me instructions to call her if I have problems or side effects.

If anyone has any suggestions, please feel free to share your thoughts and opinions.

I seriously doubt you are in ketoacidosis! Those numbers aren’t high enough. And don’t confuse “spilling ketones” with “ketoacidosis”. Even dieting can cause ketones, which is NOT dangerous by any means. However, if YOU really are worried about it (try not to be), it can’t hurt to check, PROVIDED that the test doesn’t return a false positive.

Renal thresholds vary from person to person, and the rule of thumb of spilling glucose into urine at 180 is just a rough guideline, and also does NOT indicate that one is spilling ketones!

PB - Well, that’s the reason I placed the caveat that I didn’t think I was; however, I don’t know anything about diabetes pills. Is this strong sweet urine smell a byproduct of the medication? There’s no literature on the internet or the pamphlet for Januvia about it. I know from family members who are/were on insulin, that smell is the spillage of sugar. I assume Januvia flushes excess sugar through the kidneys, but it’s a really strong, sickingly, sweet smell.

Since I’m paying out of pocket and only testing at meals and two hours after, I’m short on supplies to test if spiking in between meals. The new endo wrote down my pre-meal targets as 80-110 and post meal targets < 140. These are a lot stricter than my old endo who said anything until 200 was o.k. and really anything under 300 was o.k. on infusion days.

Have you tried buying the store brand strips?

Not yet. Can the doctor download data from those meters? I got this meter from the original endo, but my insurance won’t give me a break since I’m not on shots. This endo will only take data off the meter no spreadsheets. I’ve been getting them cheaper through ADW than my pharmacy, but they are still more expensive than they would be under a copay insurance.

I don’t like your endo’s attitude towards non-downloadable meters. Tell HIM to buy you a meter and strips that will satisfy HIS requirements. That sucks and I feel bad for you that he is so rigid (and LAZY).

Yeah, that threw me for a loop because my first endo just wanted spreadsheets and for me to test twice a day. Her nurse stressed that I had to bring my meter each visit for downloads, she does not take paper copies of readings. I’ll see her the 26th and will ask her if there is a cheaper downloadable meter and a way to get strips with a prescriptions. My meter is an accu chek nano.

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I’ve used the Nano (and like it) but now that I have Enlites, I use the Bayer Contour Next because it links to the MM pump. oh, and pretend I wrote “her” instead of “him” and “his”, in my previous post. :slight_smile:

If you are on a low carb diet, then you probably are spilling ketones because your body is burning mostly fat instead of carbs. Ketones are just a byproduct of burning fat. But, as mentioned, it doesn’t mean you’re in any danger of ketoacidosis. But, if it’s new since starting the new medication then I would think it wouldn’t hurt to contact your doctor and ask if it’s a side effect, if you are worried.

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It’s important to distinguish between ketosis, which is the ordinary and benign byproduct of burning fat through exercise, and ketoacidosis, which is a kind of out-of-control situation that arises from the absence of insulin. There’s a pretty good lay-person’s overview here:

Thanks everyone for the responses. I’m going to continue to monitor my BGs through the weekend and will contact the endo Monday if my blood sugars get worse or do not level off. I started having the urine smell just before I was diagnosed in 2013. As long as my BGs stays < 120 I don’t have it or the extreme thirst/urination, but once it creeps above it, it comes back. I’m low carbing (no pasta, bread, rice, potatoes, sweets, sodas), exercising, and Januvia. My endo does not agree with low carbo diets so her first suggestion will be to add carbs back into my diet. My cardiologist is the one who started me on a low carb diet years ago (2005).

I guess in my excitement of starting Januvia I failed to realize that the diabetes is still luring and can show up as always. :frowning:

My ankles swelled last evening and today. Not sure if it is from the Januvia or ketosis. The information sheet states swelling of the tongue but not the extremities. I’m drinking plenty of fluids. I already do a low-sodium diet so I don’t add salt to my food. I guess I’ll notify the doctor Monday morning. Frustrating.

I would tell you from my experiences with the SGLT drugs (like Jardiance) that they don’t act immediately, rather they build up, perhaps over a period of days. It may be that you haven’t seen the full action of the drug yet and the side effects that you see are not related.

It may also be that while using this drug you will be losing more sodium that you will need to actually increase your salt intake. Your doctor should test your sodium levels and you should not let them increase intake. If you have the symptoms of low sodium ([hyponatremia][1]), contact your doctor immediately.

So let me ask you. Give that we know that moving to a low carb diet requires extra salt and what I just told you about losing more salt with Jardiance, why are you doing a low salt diet?
[1]: http://www.mayoclinic.org/diseases-conditions/hyponatremia/basics/symptoms/con-20031445

When my cardiologist put me on the low carb diet many years ago (I think 2005 or so) he had already banned me from salt years before as well due to hypertension and mitral regurgitation.

That was ten years ago. Lots has happened since then. System reviews of the evidence that salt restriction helped high blood pressure found that there was almost no effect. Further evidence emerged that low sodium could actually be harmul, particularly for those of us with diabetes. It turns out sodium is central to glucose uptake and hyponatremia can cause insulin resistance (this is actually one of the complicating factors in DKA). Most recently the US dietary guidelines have looked at increasing the recommended range of sodium intake. It might be prudent to reopen the conversation and talk to your doctor about whether it is appropriate to restrict sodium. If you want pointers to these studies or the guidelines I can provide them for you.

Yes please do Brian
Thanks. He is still working with this premise when I last saw him in June. I’ll see him again in August.

Gary Taubes wrote about salt more than 15 years ago and had a piece in the NYTimes in 2012 on the issue. In 2013, the Institute of Medicine after being asked to assess the situation concluded in their report that there was insufficient evidence that restricting salt improved health outcomes. In August 2014 a massive study called Prospective Urban Rural Epidemiology (PURE) found that people who conformed to the recommended salt limits actually have more heart trouble. And finally the Academy of Nutrition and Dietetics in their comment to the 2015 US Dietary Guidelines noted that lack of evidence and highlighted the harm that could happen in inappropriately restricting sodium.

ps. The increased need for salt on low carb diets is discussed the book “The Art and Science of Low Carbohydrate Living.”

Hope that helps.

Thanks Brian for the information! I’ll present it toy cardiologist.