I posted some more information about Januvia in a comment on my original post questioning some possible side effects. Here's the link. Scroll down to the bottom of the comments see the new information:
Januvia Side Effects Post
Friday, April 20, 2007
Thursday, April 19, 2007
Best Timing for Regular Metformin
I've been fooling around with using regular metformin the past two weeks instead of the metformin ER I usually take. I've found that the trick to making it work is to time it properly. If I take it 2 hours before eating, I see the strongest blood sugar control after meals.
If you take regular metformin WITH meals, it won't get active until long after your food hits the system, which means your blood sugars will be higher than they need to be.
Once I got the timing straightened out, it seems to me that the identical dose of regular metformin gives me slightly better control than the ER version did.
But itis very hard to remember to take 3 different pills 2 hours before meals. (I usually eat breakfast a couple hours after I wake up.) So it is a trade off. The ER is convenient. I can take it all at once. But the 3 regulars give me better control at 2 out of three meals.
The regular is also tougher on the digestive tract. After 2 weeks of using it my body seems to have just about adapted, but the first week when I switched, even though I'd been taking 1500 mg of Metformin ER for years, it was Newbie City all over again, and it was a good idea to be near a bathroom at all times.
If you take regular metformin WITH meals, it won't get active until long after your food hits the system, which means your blood sugars will be higher than they need to be.
Once I got the timing straightened out, it seems to me that the identical dose of regular metformin gives me slightly better control than the ER version did.
But itis very hard to remember to take 3 different pills 2 hours before meals. (I usually eat breakfast a couple hours after I wake up.) So it is a trade off. The ER is convenient. I can take it all at once. But the 3 regulars give me better control at 2 out of three meals.
The regular is also tougher on the digestive tract. After 2 weeks of using it my body seems to have just about adapted, but the first week when I switched, even though I'd been taking 1500 mg of Metformin ER for years, it was Newbie City all over again, and it was a good idea to be near a bathroom at all times.
Wednesday, April 18, 2007
ADA Finally Recommends OGTT Testing -- 9 Years After They Told Doctors To Stop It
Today Diabetes in Control announced that the ADA has published a "Consensus Statement" recommending the use of the Glucose Tolerance Test in people at risk for impaired glucose tolerance!
http://www.diabetesincontrol.com/results.php?storyarticle=4719
The background to this story, discussed at length and documented at:
http://www.phlaunt.com/diabetes/14046782.php
is that in 1998 when the ADA's experts took another look at the diagnostic criteria that ensure that half of all people diagnosed with diabetes in the U.S. already have neuropathy and other complications at the time of diagnosis, they announced it wasn't cost effective to use the Oral Glucose Tolerance Test to diagnose people with Type 2 diabetes and told doctors to diagnose diabetes using only the Fasting Plasma Glucose test.
Researchers quickly documented that this test missed diabetes in significant numbers of women and people
of color. That is because they tend to develop diabetes in a pattern where the post-prandial blood sugar becomes extremely high long before the fasting blood sugar deteriorates. These high blood sugars cause glucose toxicity that kills beta cells and it also causes neuropathy--long before the ADA's fasting test will flag diabetes.
Despite the evidence that the fasting test was inadequate the ADA refused to change its recommendation to use only the fasting test for diagnosis, despite heavy criticism and the refusal of WHO to go along with this recommendation.
Now, finally, only nine years since the ADA's revamp of their diagnostic criteria which urged doctors to eliminate this test, they've changed their mind and are now telling doctors to use the oral glucose tolerance test for people at risk of diabetes.
The reason for this--I can't call it "sudden"--change of mind, appears to be that the ADA's experts now have decided that people with Impaired Glucose Tolerance should start taking Metformin since there is a lot of evidence that this drug can slow the progression of to diabetes. This evidence, however, is quite old. It is discussed on our Oral Drugs page.
There is, in fact, a lot more evidence that if people with Impaired Glucose Tolerance cut way back on their carbohydrate intake, they can normalize their blood sugar while they still have some beta cells left and many not need any drugs. But you won't hear that from the ADA, funded as it is by big junk food, food service and Big Pharma companies.
As usual, Dr. Meyer B. Davidson is railing against this suggestion that people be given OGTTs before they have developed neuropathy and early kidney damage because this testing is expensive. (Neuropathy is a lot more expensive, especially when it progresses to impotence or amputation). Dr. Davidson, who was a part of the ADA's 1978 expert committee as well as the more recent ones, has always volubly opposed any suggestion that people with Type 2 diabetes get a timely diagnosis. He has published many opinion pieces in the medical press arguing against early diagnosis and he also opposes the use of meters by people with Type 2 diabetes to test their blood sugar at home. He has probably done more to keep people with diabetes from getting diagnosed and treated than anyone else alive. One can only hope that he will retire soon.
My guess is that the other reason that the ADA battleship is starting to turn around on the issue of timely diagnosis is that people with IGT are a huge untapped market for the drug companies. They are a particularly juicy market for their new, and extremely expensive incretin drugs. So far, at least according to my endocrinologist, it is looking like the oral incretin drugs work much better in people with IGT than those with Type 2 diabetes. That is partly because by the time you are diagnosed using the ADA's fasting glucose test and their too-high diagnostic criteria so many of your beta cells are dead that you can drown your pancreas in GLP-1 and not much will happen. So early diagnosis means more profits for the drug companies.
Given how dependent the ADA is on Big Pharma money, if their paymasters want an earlier diagnosis, they'll get it.
This is good news for people with diabetes. I've been calling for it for 4 years online, and Europeans have been using the OGTT for the last decade. With the ADA's blessing insurers will be more likely to pay for the OGGT, too.
The bad news is that once patients get diagnosed with abnormal blood sugars, the ADA will continue to tell them that all they need to get better is to eat sugary fruits, "healthy" grains and chug those $5.65 pills each day that will counter the carbs their "healthy" diet unleashes on the blood stream. That will keep their Big Pharma donors happy.
If you are diagnosed with prediabetes or impaired glucose tolerance after a glucose tolerance test, before you start popping pills, be sure to visit Jennifer's Advice to Newbies--The Best Diabetes Page on the Web.
http://www.diabetesincontrol.com/results.php?storyarticle=4719
The background to this story, discussed at length and documented at:
http://www.phlaunt.com/diabetes/14046782.php
is that in 1998 when the ADA's experts took another look at the diagnostic criteria that ensure that half of all people diagnosed with diabetes in the U.S. already have neuropathy and other complications at the time of diagnosis, they announced it wasn't cost effective to use the Oral Glucose Tolerance Test to diagnose people with Type 2 diabetes and told doctors to diagnose diabetes using only the Fasting Plasma Glucose test.
Researchers quickly documented that this test missed diabetes in significant numbers of women and people
of color. That is because they tend to develop diabetes in a pattern where the post-prandial blood sugar becomes extremely high long before the fasting blood sugar deteriorates. These high blood sugars cause glucose toxicity that kills beta cells and it also causes neuropathy--long before the ADA's fasting test will flag diabetes.
Despite the evidence that the fasting test was inadequate the ADA refused to change its recommendation to use only the fasting test for diagnosis, despite heavy criticism and the refusal of WHO to go along with this recommendation.
Now, finally, only nine years since the ADA's revamp of their diagnostic criteria which urged doctors to eliminate this test, they've changed their mind and are now telling doctors to use the oral glucose tolerance test for people at risk of diabetes.
The reason for this--I can't call it "sudden"--change of mind, appears to be that the ADA's experts now have decided that people with Impaired Glucose Tolerance should start taking Metformin since there is a lot of evidence that this drug can slow the progression of to diabetes. This evidence, however, is quite old. It is discussed on our Oral Drugs page.
There is, in fact, a lot more evidence that if people with Impaired Glucose Tolerance cut way back on their carbohydrate intake, they can normalize their blood sugar while they still have some beta cells left and many not need any drugs. But you won't hear that from the ADA, funded as it is by big junk food, food service and Big Pharma companies.
As usual, Dr. Meyer B. Davidson is railing against this suggestion that people be given OGTTs before they have developed neuropathy and early kidney damage because this testing is expensive. (Neuropathy is a lot more expensive, especially when it progresses to impotence or amputation). Dr. Davidson, who was a part of the ADA's 1978 expert committee as well as the more recent ones, has always volubly opposed any suggestion that people with Type 2 diabetes get a timely diagnosis. He has published many opinion pieces in the medical press arguing against early diagnosis and he also opposes the use of meters by people with Type 2 diabetes to test their blood sugar at home. He has probably done more to keep people with diabetes from getting diagnosed and treated than anyone else alive. One can only hope that he will retire soon.
My guess is that the other reason that the ADA battleship is starting to turn around on the issue of timely diagnosis is that people with IGT are a huge untapped market for the drug companies. They are a particularly juicy market for their new, and extremely expensive incretin drugs. So far, at least according to my endocrinologist, it is looking like the oral incretin drugs work much better in people with IGT than those with Type 2 diabetes. That is partly because by the time you are diagnosed using the ADA's fasting glucose test and their too-high diagnostic criteria so many of your beta cells are dead that you can drown your pancreas in GLP-1 and not much will happen. So early diagnosis means more profits for the drug companies.
Given how dependent the ADA is on Big Pharma money, if their paymasters want an earlier diagnosis, they'll get it.
This is good news for people with diabetes. I've been calling for it for 4 years online, and Europeans have been using the OGTT for the last decade. With the ADA's blessing insurers will be more likely to pay for the OGGT, too.
The bad news is that once patients get diagnosed with abnormal blood sugars, the ADA will continue to tell them that all they need to get better is to eat sugary fruits, "healthy" grains and chug those $5.65 pills each day that will counter the carbs their "healthy" diet unleashes on the blood stream. That will keep their Big Pharma donors happy.
If you are diagnosed with prediabetes or impaired glucose tolerance after a glucose tolerance test, before you start popping pills, be sure to visit Jennifer's Advice to Newbies--The Best Diabetes Page on the Web.
Saturday, April 14, 2007
Merck: We'll Continue to Profit from Killing Customers
Yesterday's New York Times carried an article by reporter Gardiner Harris that tells me more than I want to know about the ethics of Merck, the company that sells Januvia.
http://www.nytimes.com/2007/04/13/us/13vioxx.html
If you may recall, Merck continued to sell Vioxx long after the company had internal information suggesting that the drug caused heart attacks and stroke. Well, this past week they were back looking for FDA approval of another drug which is closely related to Vioxx.
Let me quote Mr. Harris's article:
"A panel of federal drug advisers voted 20 to 1 Thursday to reject an application by Merck to sell its pain pill Arcoxia because of concerns that the drug could cause as many as 30,000 heart attacks annually if widely used."
Further on Harris reports:
"The studies showed that Arcoxia caused nearly three times as many heart attacks, strokes and deaths as naproxen, a popular pain pill sold as Aleve, but was no more effective in curing pain. Patients taking Arcoxia suffered worrisome increases in blood pressure."
"Merck sells Arcoxia in 63 countries"
and:
"In early studies, Merck compared Arcoxia with naproxen and found that Arcoxia was far more dangerous to the heart. So the company switched to comparing it with diclofenac, a pain medicine that is popular outside the United States and is widely believed to be more dangerous to the heart than naproxen. The company claimed that its trials showed that Arcoxia was no more dangerous than diclofenac."
Here's the punchline:
Because every doctor or researcher I have contacted in the past two weeks asking about whether the DPP-4 inhibition caused by Merck's Januvia could promote the change of melanocytes into melanoma--a cancer known to become malignant in response to DPP-4 inhibition--has told me that ONLY MERCK would have the studies to answer that question and that I should contact them.
Yeah. Right.
Yesterday's news also carried reports on the business page that Merck's stock price leapt on news of high profits from selling Januvia, which is right now their big new moneymaker.
Given the role that Januvia plays in their business plan, and this evidence that the company is willing to sacrifice the lives of tens of thousands of people to earn its profits, what hope do you think there is of getting a straight answer about Januvia's cancer risk.
If the company ever researched Januvia's effects on other DPP-4 related functions, like preventing cancer--which we can guess they have, since they've published a study showing it might be helpful for the inflammation of arthritis--any result that suggested any danger to the people taking Januvia has gone to the same place as Karl Rove's incriminating emails.
Scary, eh?
http://www.nytimes.com/2007/04/13/us/13vioxx.html
If you may recall, Merck continued to sell Vioxx long after the company had internal information suggesting that the drug caused heart attacks and stroke. Well, this past week they were back looking for FDA approval of another drug which is closely related to Vioxx.
Let me quote Mr. Harris's article:
"A panel of federal drug advisers voted 20 to 1 Thursday to reject an application by Merck to sell its pain pill Arcoxia because of concerns that the drug could cause as many as 30,000 heart attacks annually if widely used."
Further on Harris reports:
"The studies showed that Arcoxia caused nearly three times as many heart attacks, strokes and deaths as naproxen, a popular pain pill sold as Aleve, but was no more effective in curing pain. Patients taking Arcoxia suffered worrisome increases in blood pressure."
"Merck sells Arcoxia in 63 countries"
and:
"In early studies, Merck compared Arcoxia with naproxen and found that Arcoxia was far more dangerous to the heart. So the company switched to comparing it with diclofenac, a pain medicine that is popular outside the United States and is widely believed to be more dangerous to the heart than naproxen. The company claimed that its trials showed that Arcoxia was no more dangerous than diclofenac."
Here's the punchline:
"A Merck spokeswoman, Kyra Lindemann, said the company was 'disappointed in today’s outcome.'
“'We continue to believe that Arcoxia has the potential to become a valuable treatment option,' Ms. Lindemann said, adding that Merck would continue to sell the drug outside the United States.
Why does this matter for people with diabetes?Because every doctor or researcher I have contacted in the past two weeks asking about whether the DPP-4 inhibition caused by Merck's Januvia could promote the change of melanocytes into melanoma--a cancer known to become malignant in response to DPP-4 inhibition--has told me that ONLY MERCK would have the studies to answer that question and that I should contact them.
Yeah. Right.
Yesterday's news also carried reports on the business page that Merck's stock price leapt on news of high profits from selling Januvia, which is right now their big new moneymaker.
Given the role that Januvia plays in their business plan, and this evidence that the company is willing to sacrifice the lives of tens of thousands of people to earn its profits, what hope do you think there is of getting a straight answer about Januvia's cancer risk.
If the company ever researched Januvia's effects on other DPP-4 related functions, like preventing cancer--which we can guess they have, since they've published a study showing it might be helpful for the inflammation of arthritis--any result that suggested any danger to the people taking Januvia has gone to the same place as Karl Rove's incriminating emails.
Scary, eh?
Thursday, April 12, 2007
A Trial of Regular Metformin
As I discussed in an earlier blog entry, I'd noticed that my generic Metformin ER from the Teva manufacturing company was a lot peakier than the other brands and gave me a much lower blood sugar after lunch. With this in mind, I thought it might be time to see what would happen if I switched to regular Metformin instead of the extended release form.
So this week I'm taking 500 mg of regular metformin before meals (3 times a day) instead of the 1500 mg of Metformin ER which I've been taking at 10:30 AM.
So far, I'm not seeing any dramatic difference in the blood sugars, and, in fact, the post-lunch number isn't as good as before. I have noticed a stronger gastrointestinal effect: more gas and more frequent bowel movements. I'm going to give it a few more days but it looks to me like the Metformin ER has as strong an effect on the body with the advantages of less side effects and less need to remember to take the pill, since I take them all at once.
Dr. Bernstein contends in his latest book that the Glucophage brand of metformin is stronger than the generics. I haven't checked this out, but I did take the Glucophage XR version for a month without noticing anything dramatic. However, I have noticed very significant differences between other generic brands of metformin. If you aren't getting good results with yours, it might be worth asking the pharmacist if he has another generic brand you can try and see if it makes a difference. My pharmacist always fills my ER prescription with the Teva brand ever since I mentioned I was seeing much better numbers with it.
So this week I'm taking 500 mg of regular metformin before meals (3 times a day) instead of the 1500 mg of Metformin ER which I've been taking at 10:30 AM.
So far, I'm not seeing any dramatic difference in the blood sugars, and, in fact, the post-lunch number isn't as good as before. I have noticed a stronger gastrointestinal effect: more gas and more frequent bowel movements. I'm going to give it a few more days but it looks to me like the Metformin ER has as strong an effect on the body with the advantages of less side effects and less need to remember to take the pill, since I take them all at once.
Dr. Bernstein contends in his latest book that the Glucophage brand of metformin is stronger than the generics. I haven't checked this out, but I did take the Glucophage XR version for a month without noticing anything dramatic. However, I have noticed very significant differences between other generic brands of metformin. If you aren't getting good results with yours, it might be worth asking the pharmacist if he has another generic brand you can try and see if it makes a difference. My pharmacist always fills my ER prescription with the Teva brand ever since I mentioned I was seeing much better numbers with it.
Monday, April 9, 2007
Investors are Watching!
Since I posted my comments about Januvia side effects and my concerns about the effects of DPP-4 inhibition on the melanoma cancer cell, which turns out to be uniquely sensitive to DPP-4 inhibition, the investors have started visiting this blog.
Here is the link to a page on my "What They Don't Tell You About Diabetes" web site that has links to the relevant peer-reviewed research that documents the effects of DPP-4 on both wound healing and the turning of normal melanocytes to maglignant melanoma cells.
http://www.phlaunt.com/diabetes/15332388.php
Scroll down to the "Januvia" section to find the links and discussion of this topic.
I wish to reiterate here that my experience with Januvia was very positive and it was with great regret that I gave it up. But as a melanoma survivor, I do not feel it is safe to take this drug until I can get a solid answer to the question, "Since we know that DPP-4 inhibition is closely connected with the transformation of normal melanocytes (pigment cells) into malignant melanoma, do we know that inhibiting DPP-4 with Januvia (sitagliptin) does not promote this transformation?"
The cancer testing reported in the Prescribing Information does not answer this question because the in vitro testing does not look at the kinds of cancer cells that are uniquely sensitive to DPP-4 inhibition and the rodent tests are questionable because rodents are not at great risk for melanoma given that they are covered with fur.
In addition, rodent life-spans are short, as was the period in which this new drug was testing. So we know nothing about the effect of DPP-4 on slow growing human cancers over a five or ten year period. This is a drug that will be taken every day for decades if it works, so this is not a trivial issue.
Prostate cancer cells are also sensitive to DPP-4 inhibition, and since many men in their 50s have slow growing prostate cancers, establishing that Januvia's inhibition of this protease does not promote the invasiveness of that slow-growing cancer is important, too.
So, to reiterate: I am not stating that Januvia promotes cancer. I'm stating that I cannot find any peer-reviewed research into whether Sitagliptin's DPP-4 inhibition has an effect on DPP-4 sensitive cancer cells. I do find a body of research that establishes that DPP-4 inhibition is a significant feature of some cancer cells at the time they become malignant and that restoring DPP-4 expression can reverse the malignancy.
If we had not seen evidence over the past couple years that drug companies suppress laboratory evidence that could hurt the sales of their expensive drugs, I wouldn't be so concerned. But we have seen this process exposed repeatedly over the past couple years.
Januvia was approved much more quickly than any other drug that uses a novel method to achieve its ends. The DPP-4 protease it inhibits is used all over the body, not just in the pancreas and digestive system, so suppressing it enough to get dramatic effects in the pancreas can be expected to cause dramatic effects elsewhere in the body, some of which might turn out to be tragic.
If you can point me to data that addresses this issue, please let me know. I'm not happy about having my blood sugars go back to where I'm probably going to have to go back on insulin at meals.
I tried Byetta, but it was like getting hit by a truck. Obviously, I'm very sensitive to small amounts of GLP-1 or Januvia wouldn't have worked for me. Byetta sent me into hypo territory and pushed my blood pressure way, way up. Then I saw higher than usual blood sugars in the hours after it started wearing off. If I'm going to be injecting something, fast acting insulin is a much better choice for me. I didn't gain weight during my year on insulin because I use small doses and tailor it closely to my carb intake.
Here is the link to a page on my "What They Don't Tell You About Diabetes" web site that has links to the relevant peer-reviewed research that documents the effects of DPP-4 on both wound healing and the turning of normal melanocytes to maglignant melanoma cells.
http://www.phlaunt.com/diabetes/15332388.php
Scroll down to the "Januvia" section to find the links and discussion of this topic.
I wish to reiterate here that my experience with Januvia was very positive and it was with great regret that I gave it up. But as a melanoma survivor, I do not feel it is safe to take this drug until I can get a solid answer to the question, "Since we know that DPP-4 inhibition is closely connected with the transformation of normal melanocytes (pigment cells) into malignant melanoma, do we know that inhibiting DPP-4 with Januvia (sitagliptin) does not promote this transformation?"
The cancer testing reported in the Prescribing Information does not answer this question because the in vitro testing does not look at the kinds of cancer cells that are uniquely sensitive to DPP-4 inhibition and the rodent tests are questionable because rodents are not at great risk for melanoma given that they are covered with fur.
In addition, rodent life-spans are short, as was the period in which this new drug was testing. So we know nothing about the effect of DPP-4 on slow growing human cancers over a five or ten year period. This is a drug that will be taken every day for decades if it works, so this is not a trivial issue.
Prostate cancer cells are also sensitive to DPP-4 inhibition, and since many men in their 50s have slow growing prostate cancers, establishing that Januvia's inhibition of this protease does not promote the invasiveness of that slow-growing cancer is important, too.
So, to reiterate: I am not stating that Januvia promotes cancer. I'm stating that I cannot find any peer-reviewed research into whether Sitagliptin's DPP-4 inhibition has an effect on DPP-4 sensitive cancer cells. I do find a body of research that establishes that DPP-4 inhibition is a significant feature of some cancer cells at the time they become malignant and that restoring DPP-4 expression can reverse the malignancy.
If we had not seen evidence over the past couple years that drug companies suppress laboratory evidence that could hurt the sales of their expensive drugs, I wouldn't be so concerned. But we have seen this process exposed repeatedly over the past couple years.
Januvia was approved much more quickly than any other drug that uses a novel method to achieve its ends. The DPP-4 protease it inhibits is used all over the body, not just in the pancreas and digestive system, so suppressing it enough to get dramatic effects in the pancreas can be expected to cause dramatic effects elsewhere in the body, some of which might turn out to be tragic.
If you can point me to data that addresses this issue, please let me know. I'm not happy about having my blood sugars go back to where I'm probably going to have to go back on insulin at meals.
I tried Byetta, but it was like getting hit by a truck. Obviously, I'm very sensitive to small amounts of GLP-1 or Januvia wouldn't have worked for me. Byetta sent me into hypo territory and pushed my blood pressure way, way up. Then I saw higher than usual blood sugars in the hours after it started wearing off. If I'm going to be injecting something, fast acting insulin is a much better choice for me. I didn't gain weight during my year on insulin because I use small doses and tailor it closely to my carb intake.
Friday, April 6, 2007
Off Januvia for a Week
It's been very interesting going off the Januvia because it is giving me a much better sense of what the drug was doing for me besides controlling blood sugars.
Here's what's changed now that I'm off the drug:
1. My appetite has returned. Not that ravenous "feed me or I'll kill you" hunger thing that comes from blood sugar fluctuations, but my appreciation for whatever it is that is in my mouth. This makes me realize my interest in food had been really muted, possibly by some change in the brain or digestive system. Not so coincidentally, that explains why I was able to diet at an average of 1150 calories a day for a whole month while on the Januvia.
Here's an example of what I mean: For the last couple weeks while on the Januvia when we'd gone to the local pizza house for our usual lite dinner of 1/2 slice of cheese pizza with a huge salad, I'd found I could barely choke down the salad, which I remembered as being one I really liked. Yesterday we went in and after a few bites of salad I thought, "This salad is great!" I enjoyed every bite.
2. My digestive system is working again. I had noticed bloating after almost every meal, no matter how small, on the Januvia as well as increasing constipation. A few people on the diabetes.blog.com Januvia blog had insisted that this could not be caused by Januvia, claiming it did not cause delayed stomach emptying. But within 3 days of stopping Januvia I stopped experiencing bloating and everything started moving through the whole digestive system quite comfortably. One "side effect" of the normalizing of the digestive system is that my weight dropped another two pounds though I'm eating more than I did all last month. I think this reflects less stuff in the stomach and gut.
3. I am still getting frequent sinus headaches, alas, so it's possible I developed a mild sinus infection while on the Januvia which will take a while to resolve, or that the headaches aren't related, though headache is a commonly reported side effect with both Januvia and the other incretin drug, Byetta.
4. My blood sugar stayed excellent for several days after stopping the Januvia and it is still tough to decide if it is worsening. I'm not seeing as many readings in the 80s, but I am still seeing some, and since I never saw a reading in the 80s before starting insulin fifteen months ago, that is news. My fasting blood sugars went into the low 90s the last couple days and today it was back up to 106 mg/dl, though I slept in late which might have affected this. But my usual fasting blood sugar with metformin but no other drug is 108-120 mg/dl both waking and 4 hours after a meal, so I'll be looking at those fasting numbers very carefully in the next couple days.
I'm wondering if perhaps I was taking more Januvia than I needed, hence the growing effect on the digestive system. I am not all that big, and the "one size fits all" Januvia dosing has always made me wonder. Why should 141 pound me be taking the same dose as someone who weighs 280 lbs? So if I ever go back to Januvia I'll try taking a lower dose. But for now, I'm staying off it.
At the doctor's suggestion I will try Byetta now that the Januvia is officially cleared out of my system. (The Januvia Prescribing Information states that using radioactively labeled Januvia they were able to demonstrate that it is 100% eliminated from the body in one week.)
But I'm going to wait a bit longer to see if the remaining blood sugar improvement goes away or if the combination of the year on meal-time insulin and the 3 months of Januvia taught my beta cells some new tricks.
Here's what's changed now that I'm off the drug:
1. My appetite has returned. Not that ravenous "feed me or I'll kill you" hunger thing that comes from blood sugar fluctuations, but my appreciation for whatever it is that is in my mouth. This makes me realize my interest in food had been really muted, possibly by some change in the brain or digestive system. Not so coincidentally, that explains why I was able to diet at an average of 1150 calories a day for a whole month while on the Januvia.
Here's an example of what I mean: For the last couple weeks while on the Januvia when we'd gone to the local pizza house for our usual lite dinner of 1/2 slice of cheese pizza with a huge salad, I'd found I could barely choke down the salad, which I remembered as being one I really liked. Yesterday we went in and after a few bites of salad I thought, "This salad is great!" I enjoyed every bite.
2. My digestive system is working again. I had noticed bloating after almost every meal, no matter how small, on the Januvia as well as increasing constipation. A few people on the diabetes.blog.com Januvia blog had insisted that this could not be caused by Januvia, claiming it did not cause delayed stomach emptying. But within 3 days of stopping Januvia I stopped experiencing bloating and everything started moving through the whole digestive system quite comfortably. One "side effect" of the normalizing of the digestive system is that my weight dropped another two pounds though I'm eating more than I did all last month. I think this reflects less stuff in the stomach and gut.
3. I am still getting frequent sinus headaches, alas, so it's possible I developed a mild sinus infection while on the Januvia which will take a while to resolve, or that the headaches aren't related, though headache is a commonly reported side effect with both Januvia and the other incretin drug, Byetta.
4. My blood sugar stayed excellent for several days after stopping the Januvia and it is still tough to decide if it is worsening. I'm not seeing as many readings in the 80s, but I am still seeing some, and since I never saw a reading in the 80s before starting insulin fifteen months ago, that is news. My fasting blood sugars went into the low 90s the last couple days and today it was back up to 106 mg/dl, though I slept in late which might have affected this. But my usual fasting blood sugar with metformin but no other drug is 108-120 mg/dl both waking and 4 hours after a meal, so I'll be looking at those fasting numbers very carefully in the next couple days.
I'm wondering if perhaps I was taking more Januvia than I needed, hence the growing effect on the digestive system. I am not all that big, and the "one size fits all" Januvia dosing has always made me wonder. Why should 141 pound me be taking the same dose as someone who weighs 280 lbs? So if I ever go back to Januvia I'll try taking a lower dose. But for now, I'm staying off it.
At the doctor's suggestion I will try Byetta now that the Januvia is officially cleared out of my system. (The Januvia Prescribing Information states that using radioactively labeled Januvia they were able to demonstrate that it is 100% eliminated from the body in one week.)
But I'm going to wait a bit longer to see if the remaining blood sugar improvement goes away or if the combination of the year on meal-time insulin and the 3 months of Januvia taught my beta cells some new tricks.
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