Januvia vs Metformin?

Just a quick question…

I went to my Dr today for a routine physical and discussed post meal BG spikes. I asked if it would benefit me by introducing medication at this time. I find my numbers are spiking too high (200 at 1 hour) even though I generally try and keep carbs down to anything from 0-15 grams per meal with protein.

She told me that I should give Januvia a try and gave me a prescription. I’ve searched around and found some negative information regarding Januvia being a relatively new drug with complications ranging from cancer to hair loss (yikes)…

Does anyone have thoughts regarding this drug and or would you suggest maybe giving Metformin a try since its been around for a relatively long time?

Thanks for any input…


I have researched both of them extensively and personally, I would do metformin first.

Thanks, I’m leaning that way but wanted to put the question out there… My fasting numbers are pretty good (88-106) but if I have anything more than 5g carbs with a meal I’ll spike :frowning: I walk for 1.25 hours after each dinner but still seem to spike too much for my liking. I think Metformin would help at this point?


Paul I take the max dose of Metformin. If you can tolerate it go with the Metformin. Has been around along time.

As to the spikes the Metformin will not do to much. At least it doesnt for me. What are your post numbers at 2 hours?

You shouldnt be spiking that high IMHO. You may need a small dose of mealtime insulin to help with that high of spike. It still sounds to me you are very insulin deficient and you cant tolerate carbs at all. Like me your phase one insulin response is totally shot.

The metformin likely will give you better fastings but I doubt it will do alot for the spikes. Your phase 2 will limp along to get you back to your good fasting numbers.

Paul, I have been having a spike problem too for the last month. Funny you should write this post. Tonight my post 2 hour was 230 BG after supper. I am going to look into a rapid mealtime insulin. My phase 2 will take me 3- hours to bring me down I am sure.

Hi Pauly,

My 2 hour post meal is generally good (around 126 or lower). I’ve had a couple higher but that was with meals I knew would spike me. Bread is the worst offender for me. I cant even have 1 small slice of fresh whole wheat bread without seeing 200(+/-) at 1 hour so I just don’t have it.

I think if I asked my Dr for meal time insulin she would probably want me admitted into the insane asylum :frowning:

Does phase 2 run out eventually? Do most type 2’s eventually require insulin?

Thanks, Paul

About 40-50% of T-2’s eventually end up on insulin 5-10 years after diagnosis, thats often in spite of their best efforts. The rest can do it with diet, metformin and so on. For some it is more degenerative than others. I was 196 now after 3 hours. This is creepy.

Yes, 196 seems a little high at 3 hours… I had that once when I was trying different foods for breakfast; oatmeal spiked me for 3+ hours but I did enjoy it :wink:

For me I just think at 45 if I were to start taking a drug like Januvia (which is relatively new) I’m not sure what the long term complications might be, if any?

Hope your numbers come down soon and keep me posted if you introduce insulin for post meal spikes.


A bit of insulin earlier is a lot better than lots of insulin later. I would think you are insulin deficient. I also cannot eat bread regardless of the amount of insulin I inject. Early insulin use is not an absurdity the idea is to keep your own pancreas alive for as long as possible and near normal BG are good for that.


My endo suggested I go on Metformin because of cancer prevention effects. I did and am now being surprised by post prandials in the 5 and 6 mmol/l range instead of 8 average.

(Evans JM, Donnelly LA, Emslie-Smith AM, Alessi DR, Morris AD. Metformin and reduced risk of cancer of 25–37% in diabetic patients. BMJ. 2005;330:1304–5. doi:10.1136/bmj.38415.708634.F7. PMID 15849206. PMC 558205.)

Paul, have you had your c-peptide tested? That will tell you how much insulin you are still making and whether or not you should be on insulin or not. But either way, get started on some meds. I take Metformin and I just started this past Feb - the doctor never even mentioned Januvia. I am happy on the Metformin.

Bread is a biggie for me too. My diet before DX was bread, bread, and more bread. :slight_smile: I can’t believe I was able to give it up.

The only bread I eat right now is one piece of low carb toast for breakfast. It is 7 carbs. I do fine with it so I could probably have a slice at other times too but I don’t because than I will get all bread crave-y. I get it at Trader Joes but I know you are in Canada so don’t know what might be available up there. You can always buy this stuff online too if you can’t stay away from that bread. Or just find the low carb one you can and limit it.

Normal bread that isn’t low carb is like 23 carbs a slice. It is tortureous I tell you. :slight_smile: I hate looking at the nutritional labels on bread. I get frustrated and throw the loaf back on the shelf and grunt. :slight_smile:

Well, for the life of me, I don’t understand why metformin is not “THE” first line medication. Studies have shown that it has the biggest effect on HbA1c. It has been around a long time and is perhaps the best understood and safest of all the diabetes medications. And Jeez. You can get it for $4/month at Walmart.

I’m sure that no doctor would prescribe Januvia just cause it is not as effective, not as safe and more expensive than metformin. But perhaps I am harsh and the doctor is always working in your best interest.

Or are they?

OR are they influenced by the drug reps… hmmm…I HATE DOCTORS lol horrible to say but true

wow really!? I think I may go on Metformin asap this diet/exercise is taking over my life! what dose are you on? any side effects?

does anyone know if going on medicine helps save your beta cells??

Hi KimKat,

No tests yet. The only thing my Dr has told me is I’m pre diabetic. When I suggested I might be LADA she looked at me with a confused stare (so did 2 other Drs)…

The only bread I have is protein pitas. They have 5g net carbs per half a pita so if I have it with some turkey breast, cheese and baby spinach I wont spike too much…


I agree LiL,

After reading some of these comments and doing my own research I’m going to ask the Dr to change my prescription to Metformin instead. I’m only 45 and worry about being on a drug like Januvia for 5, 10 + years. I’m not sure if they even know what complications could arise after that long on it…


I’m on Janumet. It had an almost immediate and drastic (over 50+ points in the first day) effect on my BG levels. The only side effects ii experienced were about 3 days of the runs, but that is from the metformin component, or at least that’s what my research has indicated. Of course, each of us is different and your mileage will vary.

Hi yes I was on januvia and had a severe head ache everyday from it! It did nothing for my numbers at all and I walked around with this constant headache! It was awful! Honestly . I know everyone is different but yes I was loosing my hair ! Also for me it was a awful expirence! Finally I couldn’t stand it anymore and quit taking it! It did not help my numbers one bit and I feel so much better off that terriable pill! Its strange different drugs effect people differently so that doesn’t mean it will effect you this way. But for me it was a nightmare. I’m glad I’m off of it.

Wow, only 5 carb bread! That is awesome. It still affects you though unfortunatley.

I don’t know if my 7 carb stuff would affect me negatively if I wasn’t taking the Metformin. I didn’t eat it before that.

You should ask you doctor about the c-peptide. They can test it through normal blood test so if you get your A1C done you should be able to get that done too. I am surprised your doctor wants you to take a med but didn’t even check your insulin levels. Sounds like she isn’t very knowledgable about D.

I love my $4 Walmart deal with the Metformin. I wonder if Januvia is more expensive.

I think certain drs push certain drugs because they approached by the sales reps for those drugs. They get those free pamphlets and everything. I am not sure exactly how it works but perhaps they get some other freebies too (like medical equipment) if they prescribe one drug over another one.

I just notice how I could go to different doctors for different things and get different drugs that essential are supposed to do the same thing but don’t always work as well or, even worse, people are allergic to them! Just sitting in the waiting room you can sort of tell what drug companies the drs prefer with all the pamphlets and such.