Some Disturbing News about Januvia

NEW Dec 19, 2008: If you want to better understand the health issues associated with Januvia, read the Dec 8, 2008 blog post citing the research that makes it clear that a "side effect" of how Januvia lowers blood sugar is that it turns off a tumor suppressor gene making it "a trigger for prostate cancer". This same mechanism has been linked with promoting melanoma, ovarian cancer and lung cancer. None of the approval testing for Januvia investigated this problem and there is evidence it is real and affecting people taking this drug.

You can read about this important issue here:

More Research Shows Januvia and Glinides Inhibit Tumor Suppressor Gene DPP-4

Here is the original post "Some Disturbing News About Januvia":

Diabetes in Control reports last week that "According to a survey, prescriptions for the diabetes drug Januvia have grown nearly threefold between the first week of 2007 and the week ending July 20. ... It was reported that patients were switched from metformin 21%, Avandia 17% and Actos 13%."

Once again we are being treated to the spectacle of doctors who do not understand a new drug's mode of action prescribing that new drug in a way that is guaranteed to damage the health of many of those patients.

Januvia does NOT affect Insulin Resistance

Januvia stimulates insulin production after meals and may inhibit the production of glucagon after meals. That's what it does folks, and that is ALL it does.

The problem here is that for at least 21% of the Type 2s in this study, doctors were taking them off drugs that countered insulin resistance and replacing them with this drug that stimulates insulin production.

Why is this dangerous? Because for many Type 2s insulin resistance, not lack of insulin production is the primary metabolic flaw causing their high blood sugars. Their cells do not respond normally to insulin, even very high levels of insulin, resulting in very high blood sugars. Drugs that reduce insulin resistance make it possible for less insulin to do a better job.

The term "insulin resistance" is bandied around a lot, but few people really understand its practical implications. The best way to get your head around what insulin resistance means is to compare the insulin doses required to achieve normal blood sugars by people who are not insulin resistant and those who are.

A 125 lb non-insulin resistant person with Type 1 diabetes who produces no homemade insulin at all might use a basal dose of Lantus of 12 units. If they ate a meal with a moderate number of carbohydrates--let's say, 30 grams, they would inject 2 to 3 more units of a fast acting insulin to mop up those carbs.

In contrast, a Type 2 who also weighs 125 (and yes, there are quite a few Type 2s who are normal weight) if taking no other drugs might use 50 units of Lantus and need 17 units of insulin to cover that same 30 grams of carbohydrate. If that insulin resistant Type 2 were to add metformin to their daily regimen, a drug which reduces their insulin resistance, their Lantus dose might drop to 30 units and their post-meal dose to 10 units.

In either case the insulin resistant person is using three to five times more insulin to get the same effect as the non-insulin resistant person.

But the study above reports that doctors are taking people OFF the drugs that reduce insulin resistance--21% of their patients were taken off Metformin and almost the same percentages were taken off Avandia and Actos, which also affect insulin resistance.

Then doctors are putting these insulin resistant patients a drug, Januvia, that does two things: Mainly it stimulates whatever beta cells are left to produce more insulin. Though since the doctor has just taken away the metformin, the patient is going to need to produce more than they were when they were taking metformin.

Januvia may also decrease glucagon secretion--glucagon is a hormone that pushes up blood sugar and there is some likelihood that it is overproduced in people with Type 2 diabetes. Decreasing glucagon production will lower blood sugar--but it is important to note it only lowers the blood sugar dumped by the liver into the blood stream in response to glucagon production. It does NOT lower the blood sugar rise caused by the digestion of the carbohydrates in your meal.

So switching someone to Januvia from Metformin means that you've now increased their insulin resistance while at the same time giving them a drug that only stimulates a very mild increase in insulin production from whatever living beta cells they have left.

Januvia DOES work very well in some people. But the thing that doctors don't seem to understand is that the people it works well for are those people who, like me, though diagnosed as "insulin resistant type 2s" are, as I am, insulin sensitive people whose beta cells due to some flaw have stopped secreting insulin in response to rising blood sugar.

People who are insulin sensitive but have a defect that stops living beta cells from secreting will also response strongly to sulfonylurea drugs like Amaryl or Glipizide.

And they will respond very strongly to Januvia, but unfortunately, the makers of this drug have carefully NOT measured the insulin sensitivity of their subjects before putting them on the drug. If they had done this, it would probably show that Januvia works mostly in people who are insulin sensitive, but doing that would rule out giving it to most Type 2s and destroy the lucrative market for this new drug.

Anecdotal Januvia Side Effect Report Updated

I have heard recently from someone who experienced serious constipation with Januvia. The Januvia Blog also has some new reports from people who have experienced rashes after taking it.

Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.