Outraged and concerned

Kombiglyze is a combination medication consisting of Metformin and Onglyza (saxagliptin). The cautions related to lactic acidosis on Kombiglyze pertain to the metformin part of the medication. You can read the prescribing information on Onglyza (saxagliptin) and see that it has some reported mild side effects. There are of course risks with any medication as @Stemwinder_Gary points out.

That is one reason why a low-dose ACE inhibitor is often prescribed to go with metformin.

My doctor wants me on Januvia which is a similar drug. I am frightened about the side effects. My dad was on it and he had lots of side effects and it never lowered his bgs much. I really wish our doctors were more open to insulin for Type 2’s.

I agree with you @Jeannie_Wagner, I wish more doctors were open to insulin for T2’s. In their defense I believe it is because most T2’s strongly resist it. There is also the problem of familiarity, or lack of, most GP’s just do not have the training and experience to feel comfortable managing a T2 patient on insulin.

I took metformin for many years with no apparent side effects. I also took Januvia for a short while, I had no problems taking it but it provided little help with my bgs. I don’t believe it to be an ineffective drug because at the time my T2 had progressed to the point that no cocktail of oral meds was going to control it.

I was lucky in that I found a doctor that was willing to prescribe insulin. I had always dreaded the day when I would need insulin but I knew it was time. It was the best thing that could have happened. I finally had a tool that worked and it gave me a big wake up call. I knew enough about insulin to know that it is not something to be played around with so I set about the task of learning, that is how I found TuDiabetes.

Not every T2 needs insulin, oral meds and non-insulin injectables can work well for most people for a long time but when its time for insulin I would hope every T2 finds a doctor like my GP, a doctor that is not afraid.

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6-7 years ago I would not have been emotionally ready for insulin. Now I am. I was sure since I eat LC, and exercise,mused 2550 of metformin that I could mange this disease. I was obsessive about bg control and every bite I put in my mouth. I have even had my family tell me how obsessive I am. The last 6 months or so I have been losing weight, even though I a haven’t cut calories. That scares me. I was 112 this morning. I am in this catch 22. The only way for me to put weight on is increase carbs, then my bgs go up. It seems the only way my Endo or PCP a will consider insulin is if your bgs go sky high. I don’t think they realize how low carb a lot of us must eat to get above average bgs.

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Since your doctor recommended Januvia (a DPP-4 drug) perhaps you could convince him that you you would rather try a GLP-1 drug such as Byetta, Victoza, Saxenda, Bydureon, Tanzeum or Trulicity (geez do we have enough copycat drugs?). Ask to sample one and see if it makes a big difference. Most health care professionals consider the GLP-1 drugs to have a more potent effect than the DPP-4s. Once you have demonstrated that you are willing to take an injectable drug, he may be more willing to accept your request for insulin. After all you will have already gotten over the “fear of the needle.”

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As Gary intimates, one reason many doctors hesitate to prescribe insulin is that they are not sufficiently familiar with managing it. Closely coupled with that is the ever-present worry about malpractice insurance premiums.

But there are other reasons, too, and some are based on tragic differences of perception. A couple of years ago I saw a study (which I have been unable to track down again, unfortunately) that specifically investigated doctors’ and patients’ attitudes toward injections. The investigators asked doctors why they hesitated to prescribe insulin, and the #1 reason given–by about two thirds of the doctors–was that patients were afraid of needles. They also asked the same doctors’ patients whether they would in fact resist injections if offered, and only about one-third said yes. The inescapable conclusion is that there are large numbers of diabetic patients who would welcome insulin–if only it were offered!

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As it happens, there’s a blog post by Wil Dubois on dLife today discussing doctors’ and patients’ resistance to insulin (among other things).The post is here: http://www.dlife.com/diabetes/insulin/wil_dubois/insulin?utm_source=Update-20151211&utm_medium=eNewsletter&utm_content=Update-newsletter&utm_campaign=dLife-eNewsletter&

I did take Januvia and had a side-effct of severe abdominal pain after every meal while taking that. My doctor took me off of it immediately. After just 4 months of trying metformin, Amaryl and (for a short time) Januvia, the next options at the time would have been one of the injectables. My doctor already knew about my fear of needles, but coupled with my tendency to get side effects from meds, he decided that if I was going to inject anything already, the best route would be to go straight to insulin. I think it was the right choice for me. I hope @Jeannie_Wagner that you can convince your doctor to let you at least try. Maybe @Brian_BSC’s suggestion of trying one of the other injectables first will wrok. Dunno.

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One of my problems is I do too much research on these newer drugs. The side effects really scare me. I caved on the BP drug and I walk around dizzy all morning. I caved on statins, and now most of my muscles have been permanently disfigured. I am the poster child for side effects. From what I have heard about the injectibles is they work for awhile and then stop.

Neither Byetta nor Victoza worked for more than a few weeks for me. But if you demonstrate to your doctor that you have no issue injecting then it removes one barrier to getting insulin.

As I said, I seem to have a propensity to find bad side effects from meds. Januvia gave me abdominal pain after meals, Amaryl caused me to have severe, debilitating afternoon headaches and metformin (which seemed to have some quite positive side effects, by the way) so badly interrupted my sleep cycle that I was experiencing memory loss. As a result of all that, my doctor (and I, albeit reluctantly) decided to drop all the meds and go to insulin. No side effects (though I gained some unwanted weight! :frowning: ) and excellent control.

Ironically, I handle metformin pretty well, even at the max dose. I do have sleep problems, though. I was blaming it on cortisol or growing old. I am usually up 2-3 times a night and often can’t get back to sleep, My mom had the same problem and she was not a diabetic. it seems as I grow older I am getting a lot of the issues she had.

[quote=“Jeannie_Wagner, post:32, topic:48773, full:true”] My mom had the same problem and she was not a diabetic. it seems as I grow older I am getting a lot of the issues she had.
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Isn’t it awful how that works? :worried: I look at my parents’ issues and shudder sometimes… Though… my mom is T2D and to be honest, I’d love it if mine were as easily managed as hers has been…

Sleep problems are annoying - TG now that I’m not taking any meds (other than insulin) I generally do not have sleep problems and can even manage to feel rested after a night where D “woke me up” multiple times, as it so capably can…
I hope it can last, but who knows… my father seems to NEVER really sleep. EEK.

When we would visit my parents for holidays I always wondered why my mom was always tired and needed a nap. My dad would make chore lists for everyone visiting so my mom wouldn’t have to overwork. It never occurred to me she had sleep problems. When she was in Assiste Living the last 4 years of her life we had to hire extra health care workers because my mom would get up in the middle of the night and forget she needed an walker. She had many health issues but had perfect bgs to the day she died. My dad was diabetic but not until is late 80’s after many years of steroids to treat an eye disease that robbed his sight.

My mother was diagnosed as T2D when she was 15 years older than I was. She maintained it on metformin alone for 17 years, after which they incorrectly decided it had made her anemic, so put her on Amaryl instead. Currently in her mid 80’s, she’s maintaining an A1c in the low-to-mid 6’s and taking no meds for diabetes at all. She is quite overweight and absolutely sedentary (serious mobility issues due to injuries along the way). My father is her full-time caregiver (I can’t tell you how hard we’re trying to get him to accept some kind of assistance!! :scream: ) and has no clue about nutrition or carbs or any of it. If I ate like she does, my BG’s would be in the 300s continuously…

My father is convinced that my mom’s T2D was caused by Lipitor, which she started taking a few years before her Dx. She is currently not taking that anymore. A1c in the 6’s is not where I aim, but at her age and with her other issues, it’s probably safer. After around 20 years since Dx and mostly casual D-management, she is essentially free of complications. She has lost some feeling in her feet, but that could as easily be attributed to the nerve damage that she has from several herniated discs as it can to diabetes. Regardless, at this point, other concerns take precedence.

My dad was dx’d in his late 80’s. He had already been blind for about 11 years. they assured him the blindness was caused by Temperal Arteritis, not diabetes. he may have had high bg for quite awhile but who knows. Since there was absolutely no family history and he was tall and thin, maybe they never tested. I was never tested wither because I didn’t fit the profile and had 0 symptoms. They put him on Januvia and advised him to test 2 times a week. He was also told to have 5 or 6 carb items per meal. So you can imagine without testing how high he must have gone. within a year he had severe neuropathy and within 2 started to develop frequent yeast and urinary infections. He did live until almost 94, though. since my younger sister was the only one in Maine she ended up doing a lot of the care. When their health problems increased we moved them into Assisted Living. We then realized the extra nursing care was not enough and my sister couldn’t run over 10 times a day. So we hired private health care workers. In the last 6 months they worked in 3 shifts round the clock because neither of them wanted to go to a nursing home.

Interesting about the sleep issues. For the past several years I have not been able to sleep through the night. I usually get 2 to 4 hours of fairly good sleep, then wake up and have the devil’s own time falling asleep again. Often I can’t. I have put it down to age, mostly because I know many other non-PWD in similar circumstances.

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I’d fire the doctor and get one that will do the job that their being payed for and that is help the patient manage their health, to be as healthy as possible. If he won’t fire the doctor then at the least get a second opinion, perhaps that will show him the error of his ways.

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Here in British Columbia in Canada we have had a demonstration of just how far the big Pharma companies will go to push their poisons - including utterly useless diabetes medications. Abut two years ago a story broke about six employees of the government who who responsible for evaluating new prescription meds being fired for abusing the information they had access to. Of those six one committed suicide after several months of being ostracised publicly and the other five launched law suits. Guess what. They were being critical of new meds from pharmaceutical companies that provided big election funding to governing conservatives in BC. They have now all been exonerated and rehired and paid substantial compensation, although the guy who is dead - what can you say? Big pharma sucks, is immoral and is worse than the drug pushers on the corner.

I want to update how things are going with my brother. I’d like to say that I am no longer outraged and concerned, I would now say that I am Surprised and Hopeful.

I have been trying to convince him to be more engaged with his D and have been pushing for him to engage his doctor in helping him get things under control. Him showing his doctor that he was serious must have made a difference because it appears that his doctor has really stepped things up treatment wise.

I was totally surprised today when my brother called me to tell me that his doctor sent him home with a Levemir pen. Now the fight is really on because we have something we can work with. To say the least we are hopeful.

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