Januvia could trigger pancreatitis, pancreatic cancer

Gerri, You wrote on APR30th. in part: “…too many endos allow patients to have soaring BG without suggesting insulin.” (My emphasis added.)
I got a response back from my endo recently after pointing out the Januvia study discussed herein. Regarding your statement about too many doctors allowing patients to have soaring BG w/o suggesting insulin: I told her that my 2 hrs. after meal spikes of over 140 are unacceptable to me as other studies indicate such spikes are damaging to any residual pancreatic cells. She said that it often takes years for doctors to put such research into practice.

Hi Lucy,

Amazing how it takes doctors years to put research into practice, yet a CDE & my former endo both cited the very flawed ACCORD study warning that low A1cs were risky. Guess how far I got taking issue with this:) There’s selective info gathering. Imagine the “headlines” get their attention.

Truly disheartening how patients have to beg for insulin & how few people even know to demand it. Docs telling them they’re doing fine & naturally patients believe this.

Hey Gerri,

Most stuff about diabetes still doesn’t make much sense to me. For example: My fasting bs are consistently elevated over 100. This morning 126 at 9 AM. Seems to me that would mean I should eat a very low carb breakfast to prevent bs from going over 140. But nooooo, diabetes educator says to stick to average nutrient breakdown for all meals (excluding snacks) of 54 percent carbs, 22 percent protein, and 24 percent fat (believe those are around the correct percentages).

I recall noticing in the newspaper and on the TV about “flawed” intensive blood sugar lowering treatment strategy research (NIH related?) in June '08, but I was too concerned about my upcoming surgery to pay any attention to it. So thanks for bringing it up now that I have time to look into it. You wrote that it’s called the “ACCORD study.”

Hey Lucy,

I agree that eating a lot of carbs makes no sense when your BG is already high in the morning. Has that been working? Of course not. Eating 54% of meals in carbs is a lot. I’ve discarded everything my CDE & dietician told me about diet. As for those set percentages, we need to know what works for us as individuals. When I told the CDE that I was not going to eat 45-60 carbs per meal, she said I’d suffer brain damage. Oh, please! Their advice is woefully behind the times.

I have dawn phenonmenon & eat very few carbs for breakfast to curtail the increased rise. It has helped tremendously. Eating a breakfast of mostly protein also helps me from being hungry.

Yea, the ACCORD Study. It was quite flawed yet made headlines that lower A1cs were dangerous. Another thing the CDE warned me about. When I questioned her about what I had read about the study & said I read the study, she clearly hadn’t even read it. She was basing her recommendations solely on a headline, which no doubt many others did as well. I never went back to her.

Thanks Gerri, Reading your reply and others about reducing carbs gives me the courage to do so too. You replied that “advice is woefully behind the times.” When is the next revision due from those the CDE and dieticians get their info from? The majority of books about diabetes are copyrighted 2007 and earlier. At least Jenny posts updates on her web site.

Takes forever for books to get published. Not sure what you mean about the next revision due. Studies/research are done frequently. When one grabs the headlines like the ACCORD study it gets attention. CDE’s & dieticians keep learning the same ole, same ole in school. The academic world is slow to change, accepted paradigms are slow to change. The ADA advocates too high carb guidelines. Institutions, especially those receiving huge funding from the pharm industry like the ADA, have little incentive to revise their recommendations. Once the world was believed to be flat:)

Diabetics, regardless of type, have a difficult or impossible task processing carbs. Injected insulin is far from an exact science. Oral meds have their drawbacks. Seems logical to limit carbs. More carbs=more insulin needed. There are a fortunate few who can eat relatively high carb without needing correspondingly high amounts of meds or insulin & have decent A1cs, but they are rare.

Hi Andy,

Yes, fear of the unknown. Think this particular fear is exacerbated by doctors who shy away from recommending insulin.

You don’t have to pump to use insulin, but guess needles don’t sit well with you either:)

Hope you can control with exercise. That would be wonderful!

Needle phobia would be a problem. May you never need to!

Not that this is any consolation to your fear, but injections don’t hurt in the least. The needles are tiny & so narrow, that I can’t feel it at all, really. Nothing like having blood drawn for tests, thank heavens. Finger pricks hurt more.

Luckily the two medications i am on are januvia and metformin, should i be requesting a different med?

Hi Rob, Indeed, luck may be the determining factor. I’m interested in DPP-IV inhibitors, incretin-like agents, and pancreatic pathology 'cause I’m an “other” diabetic supposedly at risk for severe lows. Nevertheless, I went off Januvia after two months of no side effects and a reduction in my fasting bs and A1C (from 6.9% to 6.5%)–although I haven’t yet heard of a definite link between exenatide, DPP-IV inhibitors, or other agents on the development of pancreas cancer. Also, recently, my surgeon operated upon a person who has been taking Byetta (exenatide) for a couple years and who developed a pancreatic cancer, but no cause-effect relationship is yet confirmed. So your question about taking these classes of drugs is a good one. Some people seem to think regenerative/trophic effects of these drugs may help to expand the endocrine/insulin cell mass of some patients–like me, but they don’t yet know if these same trophic properties will result in the development of a pre-malignant change in the pancreas. I deferred to my Endocrinologist in midMay on the relative merits of these drugs, alone or in combination, to no avail. She didn’t even bother to get a copy of the full report, yet the hospital library staffer claimed she has access to it upon request. My endo’s position seemed to be the study was merely one rat study.

I suppose that makes me feel a little better. I have always dreaded the thought of creating one problem to solve another. Thanks you for the input.
RC

As a type 2 I can tell you I am scared to death to take insulin, I think the mentality(at least with me) is that there is a hope that with proper diet and excersise i will be able to get off the meds completely. I have heard that once you start insulin your body decreases its production and you are insulin dependent forever. This could be completely false… Also when you are on insulin dont you risk having lows? Also i think that as a type 2 i am still learning to cope with being a diabetic.

Initially, I was put on Levemir 8 units at bedtime to rest my pancreas. I’ve tried and am trying again, unsuccessfully to date, to control my bs with “proper” diet and increased exercise. (I walk 1 hour mornings in addition to daily yardwork and occasional gym workouts. Today I’m cutting out more dinner carbs to see if that improves my fasting bs, which was 142 this am.
My endo is leaving this summer so I’ll get to see a new endo next office visit in three months.
In the meantime, I’m going to seek another opinion as trying to control my bs with diet and increased exercise–with my history–is nonsensical to me.

Since I reported above my fasting bs of 142 on May 29 after stopping Januvia in midMay, my fasting bs seem to be improving with…diet and exercise (added ankle weights daily to 1 hour 8AM walk plus weekly dumbbell lifting for arms and increased yardwork; and some dusk time walking.)! Fasting bs history: 5/30 = 126, 5/31 = 132, 6/1 = 116, 6/2 = 112, 6/3 = 111, 6/4 = 106, 6/5 = 109.

Or else, did two months on Januvia improve beta cell function? Notably, I did experience abdominal discomfort twice, about a week apart (once at bedtime and second time just after 3AM), after going off Januvia although I didn’t experience side effects starting Januvia).

I am a type 2 and I took Januvia for six months and had some really nasty side effects. I stopped taking Januvia a month ago and now I am recovering from the problems. I still have some stomach issues, but this drug really frightens me. I tried to get my Endo to help me out, but I felt they just ignored me. I told them I had real problems with the drug that were keeping me from being able to work and my Endo never really got back with me. So I stopped taking the drug on my own and I am requesting a change in treatment. At this point I rather go back to insulin like when I was first diagnosed than deal with the side effects that creep up after a few months.

Wil, could you elaborate on the side effects? My endo just increased my dosage of Januvia and I have been getting really bad headaches and a few spells of almost passing out with numb and tingling in my left arm only…Landed me in the ER last week, echocardiagram, nuclear stress test and corotid doppler to check for heart issues and blockages all came back good. Am curious if the Januvia could have something to do with this…

Samantha

I started Jan via around January. I was put on 100 tabs right of the bat. At first things seemed ok, but after three months I started with the side effects. Here are the things I started to experience

  1. Headaches
  2. Anxiety
  3. I felt like I was having a heart attack a couple of times and went to emergency twice for this problem. I had rapid heart beat, numbness in limbs, chest pains, confusion, anxiety, cold sweats, and vomiting. They ran test and nothing came back, EKG, scans, and blood work. I think this maybe because of the stomach problems that Januvia causes. Gastric problems sometimes feel like heart attacks from what I read and felt.
  4. Insomnia
  5. Inability to think and concentrate
  6. Could not focus while thinking of complex problems.
  7. Stomach cramps. At one point I was taking metformin and Januvia together and it caused worse stomach problems.
  8. Vertigo
  9. Vision problems - I could not focus on objects and light appeared very bright.
  10. Depression
  11. Joint and muscle problems. This went away after being off Januvia in about 1.5 weeks
    When I stopped taking Januvia I had a couple of bad weeks when all the symptoms above seemed to amplify. I did not sleep a decent nights sleep for about 2 weeks. So it took about a month for most of the symptoms to be less intense. I still have stomach problems and minor headaches. I am getting spikes in my readings so glucose is all over the place right now.

It seems like a long list, but I know I did not have those types of problems while I was in just metformin and when I was in just insulin. The thing is that I never had issues like that until the past six months when I was in Januvia. I still don’t feel like I did before I started Januvia but hopefully I will soon get there.

Its a feeling you get that tells you something is not right and not until you look closely that you realize it may be the drug. I feel like I have been a zombie for the past 4 months, it gets better everyday

Hope this helps

Thank you. It helps a lot!

I have been worried it is the meds. I have been on 50mg of Januvia and was just increased to 100 about 2 weeks ago. I am also taking 30 mg of Actos and 14 units of Levimir a night.

I can relate to almost the whole list you put up. It has been somewhat hell and I’m in the service industry and it’s very hard to smile and be polite when the room is spinning around you :slight_smile:

I go back to my endo in 6 weeks but I’m not sure if I want to wait that long now.

Yep, the spinning rooms are not fun especially in front of people at work. Hope the info helps you and hope the endo listens. I think this drug is way too new and I rather deal with shots and little side effects then all these side effects from pills. I am applying the same principles to selecting diabetes medicine that I use to select software packages for companies. It seems that if we used stricter guidelines as patients when we select our treatment then at least we can deal with the consequences. We have to out weight the risk factors but we need to know them up front. What irritates me is that the endo never told me about all this extreme side effects. I had to go and find out about them on my own and through the posts of others in other sites. So I hope I was some help to you. And those side effects were reporting by Merk, they were not made up like the endo implies when I told them about them after being in Januvia for three months.

GLP-1R agonists lower glycated haemoglobin by about 0.6–1% and induce weight loss. DPP-4 inhibitors reduce glycated haemoglobin by 0.5–0.6% and have no effect on weight. The GLP-1–related drugs arrived in clinical practice with much fanfare and anticipation. DPP- 4 enzyme is a ubiquitous cell-membrane protein, expressed in many tissues, including lymphocytes, which has raised some concerns about the long-term effects of DPP-4 inhibitors, especially on immune function. Data consistent with case reports and animal studies indicate an increased risk for pancreatitis with GLP-1-based therapy and also raise caution about the potential long-term actions of these drugs to promote pancreatic and thyroid cancers. This lecture will review the incretin-based therapies with focus on their benefits and their potential transient and serious side effects.
http://www.authorstream.com/Presentation/diaalashbalbetes-1417060-glp-1-based-therapies-for-treatment-of-t2d-update-on-benefits/