Januvia, Diaformin XR, Metformin ... pills pills pills!

Type 2
1

I’ve been Type 2 for nearly ten years, with good control using diet and exercise. Eventually, though, things got out of hand, I pulled out an HbA1c of 11.2, and Metformin was prescribed by my GP. Three months later, my HbA1c is down to 8.0 which I’m feeling pretty happy about.


Today I went to see my specialist for the first time since starting the Metformin. It was a good appointment (I'm lucky to have a very good endo!), and he praised my recent weight loss efforts, and the drop in my sugars.

My problem areas: I'm still in double-digit figures (mmol) in the morning when I wake up, and we still want to get the A1c to around 7.0, as I'm 'only' 30, closer to 6.5 would be even better. In order to achieve this, without reversing my recent weight loss, I've been prescribed two new drugs to go with my Metformin - Januvia, and Diaformin XR.

The common one first: Diaformin XR is Metformin in a special coating that releases the drug slowly over time (XR stands for eXtended Release). It works in much the same way as long-acting insulin does. I take *four* tablets at night (and they're *huge* too!), and these release while I'm asleep, to bring down my morning glucose readings. Interestingly - and perhaps most disturbing - the drug seeps out of the coating, which means you then poo the empty capsules back out once the drug is released. All together now ... ewwwww!

The other one is perhaps more interesting. Januvia is a relatively new drug, and only went on to the PBS in the past month or so. This means that no generic variant is available yet, and I'm up for $30-odd once a month (without the PBS this would be around $100 though. Isn't our health system fantastic?). Hopefully a generic comes out soon. According to the endo, Januvia works similarly to Diabex and the like (which is the usual second step after Metformin), however it does not lead to weight gain, and is not likely to create hypoglycaemia. All good things. It also seems as though the side effect risk is quite low too, so I'm happy about that.

Since I'm also on the BCP, and medication for hypertension, I now have the following pills regime:

Before breakfast: 4 pills
Breakfast: 2 pills
Lunch: 1 pill
Dinner: 6 pills
Before bed: 1 pill

I'm starting to think of giving up food and just replacing it with a bowlful of pills three times day. I can have different coloured capsules to provide variety! ;)

On the other hand, if this doesn't get those blood sugars down, then I might as well give up here and now. Anyone else on a diet of different coloured pills? Care to share?
2

Has your doctor done testing to determine if you might be LADA? The usual tests are C-peptide & a full GAD antibody panel. Many LADAs get misdiagnosed T2 due to age &/or weight.

Januvia isn’t a safe drug, sorry. One side effect is high BP & it shouldn’t be taken if a person has any inflammatory diseases. Metformin has been around for a while & is considered relatively safe. B12 levels should be checked when taking Metformin.

In the US, more T2s are being prescribed insulin when diet, meds & exercise don’t work. Some just use basal insulin & this would help with your high morning BG. Others use rapid acting insulin for meals & basal insulin. Endos would rather prescribe pills because it’s easier than teaching patients to use insulin. They have a justifiable concern with hypos, but this shouldn’t be an obstacle.

3

I’ve got a pathology form to test for LADA, so I guess we’ll know soon enough. My endo actually did his PhD research on LADA, so he’s the right person to be seeing if it does turn out that that’s what I have. We did discuss insulin, so I honestly believe that he is not just taking the easy route by not prescribing it. I’m willing to try this method for a while, see what happens, and then correct as necessary from there. I have a lot of faith in the quality of care I’m receiving, they haven’t done me wrong so far, and my tests are all heading in the right direction under their care.

As for Januvia not being a “safe” drug … well, yes, it’s new, and it hasn’t had the extensive testing that other, older drugs have had. We had that discussion too. And anyway, name me a drug that is “safe” really!

Thanks for the response.

L

4

Well, I will give you my experience. But first, a word on this whole D thing. You are a veteran at this, so you basically know the ropes. But, please don’t take this the wrong way, you need to be more aggressive. The risk that you take form high blood sugars is probably much higher than the side effects of these medications. Enough said on this matter.

I am on three diabetes medications. Metformin XR (essentially the same as Diaformin XR), Actos, and Byetta. I take my medications in the morning and evening. I also take blood pressure medication and a range of vitamins and supplements. My wife says I take enough to “choke a horse.” That includes 10 fish oil gelcaps a day.

But let me be clear about my feelings on this matter. I will do what is necessary to manage my diabetes. I am not going to give up. And I don’t consider moving to insulin “giving up.” It is just another medication. I’ll consider the side effects of medications and try to make a “risk” informed decision. As Gerri notes some drugs like Januvia have some issues, Jenny Ruhl dislikes it (http://diabetesupdate.blogspot.com/2010/04/januvia-virtually-identical-to.html). I also won’t take a sulfonylurea over concerns about it’s effect burning out my remaining beta cells and my heart.

But I am fine moving to insulin.

Anyway, those are my thoughts for the day.

5

Januvia and metformin was a really bad combination for me. i threw up every day and had some really bad side effects. januvia scares me i dont think it is a safe drug.

6

Thanks for your thoughts, bsc. As for being agressive, I can do that, and I do! It’s taken me a long time to find a medical team that will work with me, and that I can trust. That might make it look like I’m giving in, but believe me, I’m not. We work together - I listen to them and (importantly) they listen to me.

I don’t think of insulin as “giving up”, either. In fact, in a lot of ways I think insulin would be more flexible, and more transparent in terms of what it’s doing to my body. I have no doubt that I will move to insulin in the not-too-distant future, if only to give myself more control. That said, the drugs provide me with the ability to be a little freer in terms of diet and exercise, they also provide me with the ability to test less frequently, and not worry about hypos and the like. Call me lazy if you wish :wink:

Put simply, I’m a very informed user of these drugs, and on my doctor’s advice I’ll happily try anything as long as I understand what it’s doing to me to create the changes it does, what the risks are, and how it will affect my lifestyle. When those factors become unworkable, I will adjust the regime to one that does offer me those things. I have been known to have many arguments with medical staff, including one with a pharmacist earlier today. I know my drugs well.

As for the risks of the drugs being higher than that of high blood sugars, I’m not quite sure what you’re driving at. Do you mean the risks of serious injury from the drugs (which is vanishingly small in most cases)? Surely, if that were the case, we’d all be running around with high blood sugars and not bothering with all the pills malarky? I don’t mean to sound argumentative, but I would like to understand the point you are making a little better.

L

7

Thanks for that. I know Metformin doesn’t agree with a lot of people. I was lucky, I had a mild squidgy feeling in the tummy and a slight touch of diarrhoea for maybe two weeks, which has now completely passed. Even when my dosage went up, the symptoms didn’t return. Be assured that if I see any kind of side effects from the Januvia/Metformin combination I’ll be straight to the hospital :slight_smile:

What scares you about Januvia?

L

8

I’m glad to hear that you want to be aggressive about your blod sugar. I also have a lot of trust issues with my medical team and we often disagree. What I mean about risks is that high blood sugars (as measured by HbA1c) are major and they are independent of cholesterol, blood pressure and smoking. A HbA1c of 6%, despite being “great control” still places you at twice the risk of heart attack over a non-diabetic HbA1c. I won’t talk about high blood sugar, you know the story. So when I compare the increased risk from something like Actos (which I consider just as dangerous as Avandia), that is what I am comparing it against. Weighing my heart attack risk from Actos agains the potential benefit I get by lowering my blood sugar, it makes the risk seem worth taking.

9

I think HbA1c is a reasonable indicator, and a good measurable target to aim for. But I also think that in terms of measuring “how am I doing really”, you need to take so much more than just an A1c into account. After all, if you’re swinging between really low and really high, you can still pull out a decent A1c, but your management leaves a lot to be desired. So, like much of life, it’s all about balance. It’s about the medication, the side effects, your daily bg readings, your blood pressure readings, your cholesterol, your lifestyle, your diet, your exercise … the list goes on. Getting all those things together is hard, sometimes it works and sometimes it doesn’t. As long as all those things are better more often than they’re worse, I think you’re not doing too badly.

I’m not sure I’m willing to spend too much time stressing over how many percentage points more likely am I to die from problem X than a normal person, though. Do what you need to do to get into a place that you’re happy with (whatever that place may be). As for the risks, take educated ones, but don’t bet everything on a dice roll.

L

10

I wouldn’t take any drug that hasn’t been on the market for 7-10 years to know what the long-term effects are. New dugs are marketed aggressively to doctors.

Areas of concern with Januvia are kidney problems, pancreatitis & that it suppresses a gene that controls immunity.

11

I totally agree with you. I am just telling you that as someone who is now on three diabetes medications and worried about the side effect issues, this was my thinking.

12

With Metformin be prepared though to get some “MET Days” that many experience. For whatever reason you feel queasy for a couple of days and have intestinal problems. These come and go every so often. Hopefully you will not experience these.

13

I started to lose my mind. i started to get panic attacks and constant migrane headaches and started to have bad sinus problems. I did not have any of those issues before januvia. also a lot of sleep problems

14

I’m on metforming and januvia and have been for a while (as well as amryl and prandin at meals) for me it works with a big emphasis on diet and exercise. I have been lucky w/ no tummy issues with these like i had w/ byetta. but then again that is me. try these meds out and see what improvements you can make in your diet or exercise routines and find out what works for you and go with it. good luck and take care!

15

Sorry to hear that, Wil, although it’s really interesting. I’ll keep an eye out for those symptoms.

L

16

Hi Pauly,

Well, three months without a “met day” so far! Thanks for the warning though :slight_smile:

L

17

Thanks for the encouragement Joe :slight_smile:

I exercise five to six days a week, for 40-60 minutes a day. I also like to get in a bike ride or three with my daughter too :wink: I’ve always eaten well, but I’m keeping a food diary at the moment to identify any ‘problem’ areas. Hopefully that in combination with the new drugs should get things nicely under control. Then, we just need to see how long it lasts! I figure if I can do ten years on diet and exercise only, then I can get a good stint in with meds only before stepping up again.

Hi Ho!

L

18

metfromin, diafromin? do theses pills lower b12 , and ok I am a little out of touch, But what is b12 and what does it do for the body?. I really would lke to know. Please bear with me because i really don’t know much about my body and it’s works. I have had diabeties for some years but never had a doctor that would listen to me or inform me about anything. I guess they think I am to stupid to understand.

19

Metformin has been found to block the absorption of vitamin B12. Being on a maximum dose of metformin for some time now, I’ve never been able to able to convince any doctor to test my B12 levels, so I supplement with high doses of B12.

20

Hi Lana! Just wanted to point out that Diabex is Diaformin is Metformin. This site is US-centric (like most, it seems), so you will see US names for meeds and US measurements. And yes this is Misty!