Oral meds?

Type 2
#1

I’m T2, and been taking metformin for it.

But now it looks like I’ve maxed it out, and will need some other meds to help. My recent HbA1c was 9.1.

My options for other medications are:

  • Janumet (not covered by insurance, but the doctor wants me on it),
  • Forxiga (not covered by insurance, and I’m not keen due to thrush and UTI issues),
  • sulphonylureas (which I’ve heard bad things about but covered by insurance),
  • Exetanide (Byetta, covered by insurance but I’m not obese)
  • Pioglitazone (covered by insurance but I know nothing about)
  • Onglyza/saxagliptin (covered by insurance but I know nothing about, or is this Janumet?)

I have no knowledge of these other meds, and would love to hear from people who have used them. I remember reading ages ago that it’s better to skip sulphonylureas and go straight to insulin, but that was before these other drugs were around (I think).

#2

You should start using insulin. Usually your dr. will let you use long acting insulin. If not enough, dr. will add short acting insulin, for bolusing with your meals.
Remember, pills are chemicals and it comes with unwanted side effects. Insulin is produced by the pancreas, if it is still working, and body friendly as such.

insulin

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#3

I take Onglyza and Pioglitizone. Definitely gained weight with the Glitizone. I might be able to stop that one if the A1c remains good. Both replaced the Sulfa I was taking. I take 2000 mg of Metformin also.

#4

Thanks for the reply.

That’s what I’m thinking too. My doctor isn’t keen on insulin. But I’ve taken it before, because when I was first diagnosed they thought I was t1 so I used it for about a year. I miss the control it gave me - the ability to actually fix a high instead of just riding it out and hoping for the best. So the more I think about it the more I think I should go back on it.

But to do that I’m going to have to convince my doctor, and that means I need to learn about the other drugs. He’s scared that insulin will cause weight gain, but the last time I was on it I actually lost a lot of weight.

Thankfully I found Jenny Ruhl’s website on these t2 meds. What a great resource!

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#5

Janumet is Januvia and Metformin. You could just as easily take the two seperately, maybe insurance would cover it that way.

farxiga does have the issue with yeast infections due to the sugar passed through your urine, if you have recurrent infections I would run from it.

Sulphonyureas are thought (but never proven ) to exhaust you beta cell creating a quicker decline. You don’t hear much about them these days.

Byetta and Victoza can help with weight loss but I don’t believe they would cause a problem for someone at ideal weight. The weight loss from these is not that great and most us us can stand to lose at least a small amount. Byetta comes in a once weekly form and I believe there is another newer drug on the market that is also once a week.

I don’t really Know the other drugs mentioned

@arpida_seru mentioned insulin, I would not reject it due to the fear factor. Doctors have done a disservice to Type two diabetics for years by threatening them with it. It is the only option that truly gives your body what it needs. It is something that should be respected not feared.

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#6

Don’t convince your doctor. Fire your doctor. Remind him/her it’s you who will suffer the complications. A1C target is 7 or below. Is your doctor trying to kill you?

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#7

At this point I would go back on insulin. Find another doc if this one won’t help you. A1c of 9 means your average bg is 210 if it’s correct, which is way too high. Your doctor should be scared about that, how long has it been at 9?

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#8

Janumet is Januvia and Metformin. You could just as easily take the two seperately, maybe insurance would cover it that way.

Great tip! Thanks!

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#9

To be honest, I’m not sure. It was stable on around 6 with metformin for ages, so I got complacent. I hadn’t been testing at all.

I had burning urine and assumed it was a UTI, so I took a probiotic which improved things a bit but not entirely.

Then one day I woke up and the fingers on my left hand were numb and stayed that way for the rest of the day, and I realised it was a blood sugar problem. My fasting test result was 16 mmol (288 mg/dl). So that was a major wake up call!

I’ve decided to try the Janumet along with my metformin for a month, and if it isn’t improving things I’ll go back and insist on insulin. At least that way I can take data to back up my request, if necessary.

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#10

I’m not that familiar with Janumet. I’d not even bother and just go back on insulin. I hope you are going to test now too. Try to get a cgm as well.

#11

I heartily second the CGM!

#12

Ok, so I tried the Janumet and it was awful. I felt terrible on it. I had the usual metformin side effects again (explosive diarrhea, stomach cramps etc) as well as feeling disconnected with the world and slowed down. I stopped it, felt better soon after, tried it again, and had the side effects so I knew it was definitely the Janumet making me feel so bad.

So I went back to my doctor and she’s prescribed a low dose sulfonylurea. I figured it’s worth a try, as it’s a lot less hassle and expense than insulin and a CGM. I’m looking at buying my first house at the moment, and money is tight.

If this med doesn’t work I’ll ask her to refer me to the nearest endocrinologist (about 3 hours away). I tried to go directly to the endo, but they said unless you have a referral you’d have to wait until next year for an appointment.

#13

My A1c was 13.2 in routine blood work when I was DX’d in December. FBG >400. Quite a shock since that was my first clue (although in all fairness I shouldn’t have been all that surprised, since both my parents were DX’d in their mid-60s & I turn 65 next week)!

At that time my doc said I’d probably need insulin & he referred me to an endo but he wanted me to start with oral meds right away to get out of the danger zone. I didn’t want to mess with met because I’d watched my roommate practically live in the bathroom for over 6 months before giving up on it, so we decided on glyburide. Between that & avoiding carbs as much as possible, I got my A1c down to 8.2 by the time I saw the endo in April, with zero side effects.

I told the endo that after watching my roommate shoot up twice a day for 7 years, I don’t have a problem with insulin. In fact, I all but flat-out asked for it because I wanted to get things under control NOW! We talked about possibly adding Victoza & cutting the glyburide when I go back in September but for now I’m getting good results with Toujeo + glyburide, average BG in the 110s & estimated A1c in the mid-5s. Not about to argue with what works… :grinning:

#14

I just recently joined this forum and came across your post. I know it was posted several months ago but wanted to respond.

I was put on Metformin immediately when diagnosed. It made me very sick just as immediately. Within 3 days I changed docs and was given the extended release version with NO problems and have taken it for 11 years now. Along the way, it was not sufficient and other oral meds were prescribed in addition to the Metformin ER. As time went on, we tried various oral meds to add to the Metformin ER. When I started Glymepride, (spelling ??), I began having lows during the night, but still having uncontrolled highs. At that point, having NO control on WHEN my body would metabolize the Glymeperide, I ASKED to go on insulin. I still take the oral Metformin ER, but also two insulins, a basal, and a meal-time insulin. I love the ability to adjust the amount of medicine needed depending upon what is going on in my life and affecting my BG levels. With oral meds, I was stuck with the same dosage at all times regardless of whether I ate 6 carbs or 26 carbs, whether I was stressed or not, whether I was active or not. I much prefer to inject rather than swallow a pill. I just wish I could get rid of the other 9 pills I take every day for various medical conditions. :wink:

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#15

Cost is a major drawback on using insulin. The oral meds I took were really cheap and the insulin I now take is very costly but I just go deeper into debt in order to use my insulins. Worth every penny my credit can absorb. :slight_smile: